The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial.

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Ndosi et al (2013) aimed to determine the clinical and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA).


In this multicentre pragmatic randomised controlled trial, 181 adults with RA, were randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The NLC interventions usually include taking history, performs physical examination, pain control, prescribing or recommending medication and dosage changes, intra-articular or intramuscular steroid injections, provision of patient education, psychosocial support and ordering blood tests or X-rays. Referrals for ward admission, to the rheumatologist or other health professionals, were carried out as appropriate. The usual RLC is like the NLC care but in allocated 15-min time slot instead of 30 minutes for NLC.

The results demonstrated that NLC was more cost-effective with respect to cost and Disease Activity Score DAS28, but not in relation to Quality-Adjusted Life-Years (QALY) utility scores. Nurse-Led Care had higher ‘general satisfaction’ scores than Rheumatologist-Led Care in week 26.