Nurse-Led Allergy Clinics Expand Access to Care and Improve Patient Satisfaction

August 15, 2022

4 minute read

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Key points to remember:

  • Nurse-led allergy clinics can successfully recruit, deliver and retain patients with in-person and remote care.
  • Both patients and healthcare providers have expressed satisfaction with the quality of care provided by these clinics.
  • Patients in particular declared satisfied with the longer moments of consultation where they felt their individual concerns were being addressed personally by an expert professional.

According to a study published in Clinical and translational allergy.

Patients and professionals said the care provided was equally acceptable, Vicky Hammerley, PhD, researcher at the Usher Institute at the University of Edinburgh, and his colleagues wrote in the study.

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According to the researchers, the current demand for specialist allergy services far exceeds the supply, hence the need to provide allergy care in community settings, especially given the growing number of people with allergies.

Nurse, patient populations

Thirty-five of the 37 invited GP practices in Edinburgh referred patients with allergy problems to nurse-led allergy clinics located at three practice centres. These clinics provided in-person care between July 2017 and March 2020 (Phase 1) and then via secure remote technology from September 2020 to February 2021 (Phase 2). Local specialist departments in pediatric and adult allergy, dermatology, ENT and respiratory medicine also supported these clinics.

The nurses running these clinics – both of whom had postgraduate qualifications in allergies and extensive secondary care experience – took allergy-focused histories during patient visits and performed clinical examinations and clinically appropriate investigations. They provided diagnostics, management advice, and relevant patient education and also communicated with the referring health care provider (HCP).

The study involved 426 patients seen during phase 1 and 40 patients seen during phase 2, focusing on suspected food allergy (phase 1, 34%; phase 2, 35%) and moderate atopic eczema to severe (phase 1, 12%; phase 2, 30%) in children under 36 months, allergic rhinitis in children and young people up to 16 years (phase 1, 2%), and suspected anaphylaxis in adults (phase 1, 52%; phase 2, 35%) . Eighty-three percent of referrals were for possible food allergy or anaphylaxis.

Additionally, 49% of stage 1 patients and 53% of stage 2 patients were ranked in quintile 5 on the Scottish Multiple Deprivation Index 2020, indicating that they came from the 20% least deprived areas of Scotland.

Opinions of patients and professionals

Patients were asked about their quality of life at baseline and between 6 and 12 weeks after their visit, with scores reduced or unchanged on all measures, the researchers found, indicating improved or unchanged quality of life for almost all measures.

Researchers also asked patients and professionals about their satisfaction with care, with 64% to 91% of respondents saying they were very satisfied with individual aspects of the service. Patients gave the highest scores to general information provided by nurses.

Additionally, 155 (42%) of patients said their allergy had improved a lot since their clinic visit, 148 (40%) said they were slightly better, 59 (16%) said they felt no change and less than 2% said they were worse or slightly worse. Almost all patients (92%) reported being able to stick to the personal management or treatment plan provided by their nurse.

The researchers further interviewed 12 general practitioners, six health visitors, a nurse practitioner, a community childcare nurse and another professional who referred patients to the clinic.

Most healthcare professionals had referred between one and 10 patients, two had referred between 11 and 20 patients, and two had referred between 21 and 30 patients. Although most of these healthcare professionals said the referral process was easy, they suggested adding the clinic to the Scottish Care Information (SCI) portal, which integrates the primary and secondary care systems.

Additionally, healthcare professionals had mean scores of 4.3 to 4.7 on a satisfaction scale of 1 (not satisfied) to 5 (very satisfied) when rating all aspects of their care. patients in these clinics.

Healthcare professionals rated ease of access, fast appointment times, reduced wait times, the ability to see an experienced healthcare professional, and time allowed for discussion as the best aspects of these clinics.

Worst aspects included requests to use the SCI Gateway for referrals, discharge summaries including prescription information, and shorter wait times for clinic appointments.

The researchers also conducted structured interviews with 16 patients and/or caregivers, all of whom were impressed with the clinic and satisfied with their experience there.

These patients and caregivers said that the time they spent with an experienced specialist nurse improved their knowledge of their allergies, gave them a greater sense of control over their allergies, and improved their quality of life as a result.

While the consultations focused on practical ways to minimize the impact of these allergies on daily life and deal with the anxieties of allergic symptoms, these patients also reported feeling more supported and appreciating the convenience of the local clinic. .

The local and familiar location of these clinics also made it easy to attend, eliminating transportation issues. In fact, the researchers wrote, some patients indicated that they might not have attended the clinic if it had been based in a hospital.

Additionally, patients were impressed with how little time elapsed between the referral and their visit to the nurse, particularly because of the anxieties they felt about their allergies.

Patients said these consultations were also helpful, given the nurses’ expertise in allergies and how to live with them, in addition to the tests carried out at the clinic, some results of which were provided immediately.

These consultations, which patients said took longer than expected, allowed for discussions that covered all patient concerns, unlike consultations with GPs where patients said they felt rushed.

Patients reported feeling satisfied and confident in the care provided by these nurses and felt like they left these visits with a clear plan on how to manage their day-to-day allergies, including training on auto-injectors and other practical advice in addition to their emotional needs.

The researchers also interviewed nine healthcare professionals, all of whom were positive about the service and said these clinics filled an existing gap. The referral process was simple, these respondents said, because communication with nurses and post-discharge care were easy. Respondents also appreciated how the clinics were run by nurses with specialist knowledge.

These clinics did not reduce the workload of healthcare professionals, the researchers continued, but they particularly addressed a need for young adults who lacked transitional or adult allergy services in Edinburgh while still providing accessibility due to their local presence.

Overall, the researchers concluded that both in-person and remote models of these nurse-led allergy clinics were acceptable, feasible, and effective in providing care for patients with suspected or confirmed food allergy, eczema , allergic rhinitis and anaphylaxis, although their effectiveness should be confirmed by a formal randomized controlled trial.

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