Specialist nurse-led intervention to treat and control @entity101 and @entity407 in XXXX (SPLINT): a randomized controlled trial.

@entity407 @entity1 @entity101 @entity6 @entity165
OBJECTIVE: To determine the effectiveness of specialist nurse-led clinics for @entity101 and @entity407 provided for @entity6 @entity1 receiving hospital-based care. RESEARCH DESIGN AND METHODS: This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure(>or=140/80 mmHg), raised total @entity165 (>or=5.0 mmol/l), or both. Individuals with @entity6 were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for @entity1 , with attendance every 4-6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. @entity1 with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total @entity165 values were obtained from the Salford electronic @entity6 register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in @entity101 and @entity407 , attributable to the specialist nurse-led intervention. RESULTS: Overall, specialist nurse-led clinics were associated with a significant improvement in @entity1 achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in @entity1 enrolled in the specialist nurse-led clinic for @entity407 (OR 1.69 [1.25-2.29], P = 0.0007) than for @entity101 (OR 1.14 [0.86-1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32-0.92], P = 0.02). CONCLUSIONS: This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of @entity1 with @entity6 . If the standards of care recommended in the National Service Framework for @entity6 are to be achieved, then such proven methods for delivering care must be adopted.
