Mixed‐methods evaluation of a nurse‐led allergy clinic model in primary care: Feasibility trial

Abstract

Introduction:It is now widely acknowledged that there are serious shortcomings in allergy care provision for patients seen in primary care. We sought to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and estimates of the potential impact of the intervention on disease-specific quality of life.Methods: Mixed-methods evaluation of a nurse-led primary care-based allergy clinic in Edinburgh, UK undertaken during the period 2017-2021 with a focus on suspected food allergy and atopic eczema in young children, allergic rhinitis in children and young people, and suspected anaphylaxis in adults. Prior to March 2020, patients were seen face-to-face (Phase 1). Due to COVID-19 pandemic restrictions, recruitment was halted between March-August 2020, and a remote clinic was restarted in September 2020 (Phase 2). Disease-specific quality of life was measured at baseline and 6-12 weeks post intervention using validated instruments. Quantitative data were descriptively analysed. We undertook interviews with 16 carers/patients and nine healthcare professionals, which were thematically analysed. Results:During Phase 1, 426/506 (84%) referred patients met the eligibility criteria; 40/46 (87%) of Phase 2 referrals were eligible. Males and females were recruited in approximately equal numbers. The majority (83%) of referrals were for possible food allergy or anaphylaxis. Complete data were available for 338/ 426 (79%) patients seen in Phase 1 and 30/40 (75%) in Phase 2. Compared with baseline assessments, there were improvements in disease-specific quality of life for most categories of patients. Patients/carers and healthcare professionals reported high levels of satisfaction, this being reinforced by the qualitative interviews in which convenience and speed of access to expert opinion, the quality of the consultation, and patient/care empowerment were particularly emphasised.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Nurse‐led clinics in primary health care: A scoping review of contemporary definitions, implementation enablers and barriers and their health impact

“…Overall, the final group of publications included nine Randomised Control Trials (Bleijenberg et al., 2016; Harrison et al., 2008; Houweling et al., 2011; Imhof et al., 2012; Jacobs et al., 2007; Murchie et al., 2003; Salisbury et al., 2002; Sande et al., 2020; Williams et al., 2005), nine qualitative studies (Clendon & White, 2001; Lindsay, 2001; Marshall et al., 2011; McNeal, 2019; Mills et al., 2012; Minstrell et al., 2015; Nymberg & Drevenhorn, 2016; Pritchard‐Jones et al., 2015; Sullivan et al., 2022), three evaluation studies (Coddington et al., 2011; Dalton et al., 2023; Fernandez, 2007), four cross sectional studies (Fuller et al., 2020; Kor et al., 2022; Krothe & Clendon, 2006; Miles et al., 2003). In addition, four mixed methods studies were included (Frasso et al., 2017; Hammersley et al., 2022; Hegney et al., 2013; Wong & Chung, 2006), along with two cohort studies (Barello et al., 2022; Harvey et al., 2018), two multi‐methods studies (Hegarty et al., 2013), a needs analysis (Clendon & White, 2001), a case study (Callaghan et al., 2012), a secondary analysis (Bleijenberg et al., 2017) and an action research study (Mills & Fitzgerald, 2008).…”

“…For example, this was observed among teens with asthma (Salisbury et al., 2002), with diabetes management among older people (Houweling et al., 2011), and with the frail aged (Bleijenberg et al., 2016; Imhof et al., 2012). However, in some cases, quality of life was demonstrated to be vastly higher among clients after attending a nurse‐led clinic associated with symptom management of allergies (Hammersley et al., 2022), or with continence care and support (Williams et al., 2005). There were mixed outcomes in term of quality of life, however one study highlighted that despite the nurse‐led clinic not changing quality of life outcomes compared to standard care, what the nurse‐led clinic offered was commensurate care.…”

“…These longer consultation times were reported to enable a more holistic care approach being used. This led to improvements in disease‐specific knowledge and greater sense of empowerment associated with a client's condition, while also impacting on quality of life (Callaghan et al., 2012; Fuller et al., 2020; Hammersley et al., 2022; Harvey et al., 2018; Laurant et al., 2005; Marshall et al., 2011; Sande et al., 2020).…”

“…The longer consultation time enabled greater communication and a more personal and trusted relationship being developed between nurse and client. This allowed a shift in focus from symptom management, to providing time for questions to be asked, and greater insights to be provided to clients (Fuller et al., 2020; Hammersley et al., 2022; Hegney et al., 2013; Houweling et al., 2011; Lindsay, 2001; Marshall et al., 2011; Nymberg & Drevenhorn, 2016; Salisbury et al., 2002; Sande et al., 2020). The additional time impacted on the daily lives of clients in terms of their health literacy, navigating their condition, feeling more invested in self‐managing their health.…”

“…The additional time impacted on the daily lives of clients in terms of their health literacy, navigating their condition, feeling more invested in self‐managing their health. This improved compliance such as medication management, diet and exercise, and addressing any anxieties they may have associated with their condition (Fuller et al., 2020; Hammersley et al., 2022; Houweling et al., 2011; Lindsay, 2001; Marshall et al., 2011; Nymberg & Drevenhorn, 2016; Salisbury et al., 2002; Sande et al., 2020). Overall, it was found that clients felt more supported and appreciated compared with standard care (Hammersley et al., 2022).…”