A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis

Background. The practice nurse is central to the development of a primary c are-led National Health Service. Skin diseases can have a major impact on p atients' lives but general practitioners (GPs) lack many of the skills of p ractical dermatology care and support Aim. To determine whether a primary care dermatology liaison nurse should b e introduced by our health authority. We identified the resources consumed and the benefits that accrued from a practice nurse who had received traini ng in practical dermatology care. Method. A cost consequence study in paral lel with a randomised controlled trial was undertaken in a group of nine GP s and 109 patients between the ages of 18 and 65 years who had a diagnosis of psoriasis or eczema. Results. Although there was a significant improvement in our primary outcom e measure within group, when compared with the control group significance w as not achieved. There was no significant change in the Euroqol measure but the clinical instrument showed a significant change when compared with con trol. On entry, our qualitative data identified three main themes - the emb arrassment caused by these skin conditions, the wish for a cure rather than treatment, and concern over the long-term effects of steroids. On completi on, 20% of patients expressed that they had received a positive benefit fro m the clinic. Conclusion. This study demonstrates the difficulties of obtaining relevant information to facilitate decisions on how resources should be allocated in primary care. Not all questions can be answered by large multi-centred tri als and studies themselves have an opportunity cost consuming resources tha t could otherwise be spent on direct health care. Often, local resource dec isions will be based on partial evidence-yielding solutions that are satisf actory rather than optimum but which are, nevertheless, better than decisio ns taken with no evidence at all.