EFFECTIVENESS AND PATIENT SATISFACTION WITH NURSE-DIRECTED TREATMENT OF BARRETTS-ESOPHAGUS

Objective: Using clinical practice guidelines, a registered nurse adju sted antireflux medications, evaluated esophageal biopsy reports, dete rmined the interval between surveillance endoscopies, and provided edu cation for patients with Barrett's esophagus, No previous reports have assessed the effectiveness or patient satisfaction associated with re gistered nurse-provided primary care. Because estimates of the inciden ce of dysplasia and adenocarcinoma vary widely, we also prospectively followed a cohort of patients with Barrett's esophagus, Methods: Chart s were reviewed to determine the frequency of variation from guideline s, the annual incidence of dysplasia and adenocarcinoma, and frequency of reflux symptoms. Patients were mailed a questionnaire to assess sa tisfaction with their medical care and with the nurse. Results: Variat ion by the nurse from the guidelines on surveillance endoscopy (1.9%) and the treatment of reflux (1.3%) was rare. best patients were very s atisfied (score of 6 on 0-6-point Likert scale) with overall medical c are (88%), and patient education (76%), and most patients did not thin k that increased physician involvement would improve their care (93%), Ninety-seven percent of patients had control of reflux symptoms. Two patients with long segment Barrett's esophagus (n = 67) developed high grade dysplasia over 323 patient-yr of follow-up (1 of 162 patient-yr for an annual incidence of 0.6%). No patients with short segment Barr ett's esophagus (n = 56) developed high grade dysplasia or adenocarcin oma over 172 patient-years of follow-up. Conclusion: The registered nu rse in our clinical setting effectively administered clinical practice guidelines for the management of Barrett's esophagus without clinical ly significant morbidity or patient dissatisfaction. Before these resu lts can be generalized to other settings, further studies will need to be performed. (C) 1998 by Am. Coll. of Gastroenterology.