The Parkinson's Disease Society set up a study where five PDNS worked in selected District General Hospitals in association with medical teams to establish PD clinics and network with other health care professionals involved in the care of people with PD. This study was performed to compare the effects of follow up by a PDNS compared with consultant neurologist (control) led care. A randomised evaluative design was used only two (out of 22) differences were found where physical functioning and general health improved in the control group. Provision of PDNS' for patients with PD cannot be recommended solely on cost effectiveness because of similar outcomes but increased costs associated with the PDNS providing additional care. However medical and nursing specialists valued their complementary expertise and patients and corers responses to consultation reflect that PDNS have a particular contribution (Reynolds et al 2000).

A further community study (Jarman 1998) has evaluated health outcomes and costs of community based PDNS in nine areas of England. Patients were randomly assigned to a PDNS or ordinary care through a GP. Invitations went to 3,124 patients with 1,859 consenting to participate. 818 were assigned to GP care 1,041 to care by a PDNS. The nurse visited at 8 weekly intervals. After the first year the nurse group demonstrated better care measured by reduced excess mortality, fractures, falls and hospital inpatient time. There were marginal increases in drug costs but reduced nursing home and hospital costs giving a net saving of £300 per patient per annum in year 1.

In a later presentation of the data which is still to be published responses to the global questionnaire were significantly better from the nurse group (p=0.006). Stand up Group 2 (unable to stand without help) demonstrated a highly significant difference in mortality in favour of the nurse group (p=0.001). In this group nurses were also more successful in keeping patients at home instead of moving them into institutions reflected in a saving in institutional costs of borderline significance (p=0.07)

The author's interpretation of the data was that although nurses did not improve on ordinary care in mild or advanced disease they did have a significant positive effect among patients with moderate disease.

There are about 120,000 people with Parkinson's in the UK and caring for this group of patients is costly. The PDNS can contribute to the management of care for these individuals and at the same time provide support for carers. Next