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Title: Evaluating a model of nurse-led care in a genitourinary medicine clinic
Author: Miles, Kevin Vincent
ISNI:       0000 0001 3398 426X
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 2002
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The development of advanced practice roles for nurses working in the speciality of genitourinary medicine (GUM) is part of a wider process of change in nursing and the National Health Service. Despite the paucity of evidence of their effectiveness, there has been a steady growth of nurse-led GUM clinics over the past decade. This thesis explores the impact of nurse-led GUM clinics for women in a central London GUM service. A process and outcome evaluation was conducted to demonstrate the effectiveness, acceptability and cost of nurse-led GUM clinics. 880 women were randomised to nurse-led or doctor-led clinics of whom 224 had their clinical records audited. A further (non-randomised) sample of 282 women completed a satisfaction survey, 20 completed an exit interview and 18 had their consultation observed. Staff completed 586 waiting time surveys. Staff interviews and focus group discussions identified the issues associated with the nurse-led clinic intervention. A cost analysis determined the average, incremental and marginal costs of nurse-led clinics. The median documentation audit scores for specialist nurses (n=103) and senior house officers (SHOs) (n=121) were 92% and 85% respectively (p<0.0001). Specialist nurses performed equally to the SHOs with regard to requesting the correct diagnostic tests, preliminary diagnosis and treatment. The median satisfaction scores, out of a total of five, were 4.47 and 4.30 for the nurse-led and doctor-led groups respectively (p=0.05). There was no significant difference in the consultation times. Following the introduction of nurse-led clinics, the average cost per patient rose from £8.80 to £8.88 with a marginal cost of £9.43 per patient. The study concluded that trained, experienced specialist nurses supported within the multidisciplinary team were at least as effective in the assessment and management of female patients as SHOs. The model of nurse-led care was acceptable to patients and a cost-effective addition to existing services.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Health services & community care services