NP-led Care Improves Quality of Life for Multiple Sclerosis Patients

The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Depression improved with add-on nurse practitioner (NP)–led care in comparison with usual neurologist care at 3 and 6 months for patients with multiple sclerosis (MS): satisfaction with care was the same in both groups.

  • Additional research is necessary to examine how NPs could enhance care for patients with MS in healthcare environments.

Why This Matters

  • Providing care for people with MS is becoming more complex, and there is a need of innovation.

  • Owing to high MS rates in Canada, general neurologists encounter challenges in delivering optimal care for MS patients in their busy office settings.

  • Treatment gaps and unmet needs of people with MS underscore the need for alternative ways to provide care.

  • This study attempted to assess the effects of add-on NP-led care for people with MS who had depression and anxiety (assessed with the Hospital Anxiety and Depression Scale [HADS]), compared to usual care (community neurologist, family physician).

Study Design

  • People under the care of community neurologists were randomly assigned to add-on NP-led care or usual care for 6 months.

  • The primary outcome was the change in HADS score at 3 months.

  • Secondary outcomes consisted of HADS (6 months), EQ5D, MSIF, and CAREQOL-MS scores at 3 and 6 months and Consultant Satisfaction Survey results at 6 months.

  • The researchers enrolled 248 participants, of whom 228 stayed in the trial until the end (120 in the NP-led care arm and 108 in the usual-care arm). There were no major differences between the two groups at baseline.

  • Participants were highly educated (71.05%), were employed full time (41.23%), and living independently (68.86%). The mean age of the patients was 47.32 (SD, 11.09) years, the mean EDSS score was 2.53 (SD, 2.06), the mean duration since MS diagnosis was 12.18 (SD, 8.82) years, and 85% had relapsing-remitting MS .

Key Results

  • Mean change in HADS depression score (3 months) was -0.41 (SD, 2.81) for the NP-led care group, vs 1.11 (SD, 2.98) for the usual-care group (P = .001), which was sustained at 6 months; for anxiety, it was -0.32 (SD, 2.73) for NP-led care group, vs 0.42 (SD, 2.82) for the usual-care group (P = .059).

  • Other secondary outcomes were not substantially different. There was no difference in satisfaction of care in the NP-led care arm (63.83 [SD, 5.63]) in comparison with the usual-care group (62.82 [SD, 5.45]; P = .194).

Limitations

  • Participants self-reported their data, rendering them susceptible to subjective bias.

  • The patients are presumably enrolled in the study if they were open to being managed by an NP in addition to their community neurologist; They probably perceived involvement of an NP from a positive perspective, which could influence the finding of a similar degree of consultant satisfaction between arms.

  • The duration of the study was limited to 6 months, which may not be sufficient to observe a significant change in a patient’s HADS, MFIS, or EQ5D score. Nonetheless, there was an encouraging trend that NP-led care can positively influence or delay the decline of quality-of-life measures, such as depression, for people with MS.

  • The researchers did not evaluate the add-on aspects to NP-led care in the MS subspecialty clinic settings.

  • The study was conducted in a public healthcare system in Canada.

Study Disclosures

This is a summary of the preprint research study, “The Effect of Nurse Practitioner (NP-led) Care on Health-Related Quality of Life in People with Multiple Sclerosis ― A Randomized Trial,” written by Penelope Smyth from the University of Alberta, published on medRxiv, and provided to you by Medscape. This study has not yet been reviewed. The full text of the study can be found on medRxiv.org.

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