A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis.

Abstract

BACKGROUND: The practice nurse is central to the development of a primary care-led National Health Service. Skin diseases can have a major impact on patients' lives but general practitioners (GPs) lack many of the skills of practical dermatology care and support. AIM: To determine whether a primary care dermatology liaison nurse should be introduced by our health authority. We identified the resources consumed and the benefits that accrued from a practice nurse who had received training in practical dermatology care. METHOD: A cost consequence study in parallel with a randomised controlled trial was undertaken in a group of nine GPs and 109 patients between the ages of 18 and 65 years who had a diagnosis of psoriasis or eczema. RESULTS: Although there was a significant improvement in our primary outcome measure within group, when compared with the control group significance was not achieved. There was no significant change in the Euroqol measure but the clinical instrument showed a significant change when compared with control. On entry, our qualitative data identified three main themes--the embarrassment caused by these skin conditions, the wish for a cure rather than treatment, and concern over the long-term effects of steroids. On completion, 20% of patients expressed that they had received a positive benefit from the clinic. CONCLUSION: This study demonstrates the difficulties of obtaining relevant information to facilitate decisions on how resources should be allocated in primary care. Not all questions can be answered by large multi-centred trials and studies themselves have an opportunity cost consuming resources that could otherwise be spent on direct health care. Often, local resource decisions will be based on partial evidence-yielding solutions that are satisfactory rather than optimum but which are, nevertheless, better than decisions taken with no evidence at all.