Author Of 1 Presentation
P0207 - Effects of Nurse Practitioner Care compared to Community Neurologist Care on Depression and Anxiety Levels in People with MS: a randomized trial (ID 311)
Abstract
Background
Canada has one of the highest rates of MS in the world. As treatments for people with MS (PwMS) become more comprehensive, it is challenging for general community neurologists to optimally provide care with the pressures of busy office practices in a public health care system. Specialized nurse practitioners (NPs) provide advanced skills to those with complex medical conditions such as PwMS, with potential to enhance care for PwMS.
Objectives
Our objective was to evaluate the effect of NP-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS) compared to ‘usual care’ (community neurologist and MS specialized RN nursing).
Methods
PwMS followed by community neurologists were randomized to NP-led (NP) or usual care (CN) for 6 months. Primary outcome was the change in the anxiety and depression sub-scales of the HADS at 3 months. Higher scores indicate greater severity. Secondary outcomes included HADS-A and HADS-D at 6 months, quality of life as measured by the EQ5D (3, 6 months), fatigue as measured by the MSIF (3, 6 months), and the Consultant Satisfaction Survey (3, 6 months).
Results
We recruited 248 subjects; 226 completed the trial (NP arm n=118, CN arm n=108). There were no baseline differences between groups. Study subjects were highly educated (72%), working full-time (42%), living independently (69%), with mean age of 47 (SD 11.02) and mean duration since MS diagnosis of 12.45 years (SD 8.73). Most had relapsing remitting MS (85%), with mean EDSS of 2.54 (SD 2.07). The mean change in HADS-D at 3 months was: -0.41 (SD 2.81) NP group vs 1.11 (2.98) CN, p=0.001; and for HADS-A, -0.32 (2.73) NP vs 0.42 (2.82) CN, p=0.059, similar at 6 months. There were trends, but no significant changes in MSIF and EQ5D from baseline in either arm at 3 and 6 months. There was no difference in patient satisfaction with the NP-led care compared to usual care (63.83 (5.63) for NP group vs. 62.82 (5.45) for usual care, p=0.194).
Conclusions
NP-led care improved depression (at 3 and 6 months) and anxiety levels (at 6 months) in PwMS; there was no difference in patient satisfaction with care between NP and community neurologist. Further research with longer follow-up is needed to explore how NPs could enrich and supplement the care provided for PwMS in a Canadian public healthcare system.