Nurse practitioner's knee injection clinics in the UK: The patient's perception

Nurse practitioners play a vital role in the modernization program of the National Health Service in the United Kingdom. They are being encouraged to take up the role of a clinician. A new concept of collaborative work between two professionals is being established despite strong resentment among some doctors. Traditionally, clinicians inject Synvisc(TM) intra-articularly to treat symptoms of knee osteoarthritis; however, it is perceived that nurse practitioners could provide the same service. Currently there is no study evaluating the qualitative aspect of this treatment, the patient's experience of the care as well as clinical outcome. We hypothesise that a clinician led injection clinic will lead to better patient satisfaction than a nurse led service. The study design was a non-randomised, prospective, clinical audit. One hundred patients of mean age 62.5 years with knee osteoarthritis requiring intra-articular injection therapy as part of their management, (50 in each of the nurse practitioners and clinician clinic) sequentially selected from October 2002 to May 2004 were included in the study. They were followed up for 3 months. All patients were treated by 3 Synvisc(TM) injections, once weekly. They were asked to complete a short questionnaire at the time of the final injection, Oxford knee score and 100 mm visual analogue pain scale before and 3 months after the injection. They were prospectively followed up by the authors and monitored to assess the clinical outcome. The data were analysed by an independent clinician. There was improvement in terms of pain relief in both the groups. The scores on the visual analogue scale mean 73.2-32.8 in the nurse practitioner's clinic and 70.8-36.6 in the clinician's clinic. Oxford knee scores improved in the clinician group mean 51-33.7 points and the nurse practitioners group mean 48.9-32.8 points at 3 months of follow up. Nurse led service is better in terms of fewer complications as participants in the clinician injection group had significant injection site pain (p < 0.001). 90% of nurse led injection clinic patients were very satisfied about the service (p < 0.001). We concluded that the nurse practitioner's injection clinic is an effective means of resource regeneration. This study shows collaborative work between allied professionals could provide better patient care. (C) 2005 Elsevier Ltd. All rights reserved.