Infectious Disease

Nurse-led allergy clinics expand access to care, improve patient satisfaction

August 15, 2022

4 min read

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Key takeaways:

  • Nurse-led allergy clinics can successfully recruit, deliver and retain patients with in-person and remote care.
  • Patients and health care providers both expressed satisfaction with the quality of care that these clinics provided.
  • Patients particularly reported satisfaction with the longer consultation times where they felt like their individual concerns were personally addressed by an expert professional.

Allergy clinics led by nurses successfully recruited, delivered and retained patients while providing successful care in person and through remote consultations, according to a study published in Clinical and Translational Allergy.

Patients and professionals alike said the care that was provided was acceptable as well, Vicky Hammersley, PhD, research fellow with the Usher Institute at The University of Edinburgh, and colleagues wrote in the study.

Source: Adobe Stock

According to the researchers, current demand for specialist allergy service far outweighs its supply, prompting a need to provide allergy care in community settings, particularly considering the growing numbers of people with allergic conditions.

Nurse, patient populations

Thirty-five out of the invited 37 general practices in Edinburgh referred patients with allergic problems to nurse-led allergy clinics located in three hub practices. These clinics provided care in person between July 2017 and March 2020 (phase 1) and then via secure remote technology from September 2020 to February 2021 (phase 2). Local specialist services in pediatric and adult allergy, dermatology, ENT and respiratory medicine supported these clinics as well.

The nurses leading these clinics — both of whom had postgraduate allergy qualifications and extensive secondary care experience — took allergy-focused histories during patient visits and they conducted clinical exams and clinically appropriate investigations. They provided diagnoses, management advice and relevant education to the patient and communicated with the referring health care provider (HCP) as well.

The study involved 426 patients seen during phase 1 and 40 patients seen during phase 2, focusing on suspected food allergy (phase 1, 34%; phase 2, 35%) and moderate to severe atopic eczema (phase 1, 12%; phase 2 , 30%) in children aged younger than 36 months, allergic rhinitis in children and young people up to age 16 years (phase 1, 2%), and suspected anaphylaxis in adults (phase 1, 52%; phase 2, 35%) . Eighty-three percent of referrals were for possible food allergy or anaphylaxis.

Also, 49% of the patients in phase 1 and 53% of the patients in phase 2 were classified as quintile 5 on the Scottish Index of Multiple Deprivation 2020, indicating that they came from the 20% least deprived areas of Scotland.

Patient, professional opinions

Patients were surveyed about their quality of life at baseline and between 6 and 12 weeks after their visit, with reduced or unchanged scores in all measures, the researchers found, indicating improved or unchanged quality of life for almost all measures.

Researchers surveyed patients and professionals about their satisfaction with care as well, with 64% to 91% of respondents saying they were very happy with individual aspects of the service. Patients gave the highest scores to the general information provided by the nurses.

Also, 155 (42%) of the patients said their allergy had gotten much better since visiting the clinic, 148 (40%) said they were slightly better, 59 (16%) said they felt no change and less than 2% said they were worse or slightly worse. Nearly all the patients (92%) said they were able to stick to the personal management or treatment plan their nurse provided.

The researchers additionally surveyed 12 general practitioners, six health visitors, one practice nurse, one community nursery nurse and one other professional who referred patients to the clinic.

Most of the HCPs had referred between one and 10 patients, two had referred between 11 and 20 patients, and two had referred between 21 and 30 patients. Although most of these HCPs said the referral process was easy, they suggested adding the clinic to the Scottish Care Information (SCI) Gateway, which integrates primary and secondary care systems.

Further, the HCPs had mean scores of 4.3 to 4.7 on a satisfaction scale of 1 (not happy) to 5 (very happy) when rating all aspects of their patients’ care at these clinics.

The HCPs called the ease of access, quick appointment times, reduced waiting times, the ability to see an experienced HCP and the time allowed for discussion as the best aspects of these clinics.

The worst aspects included requests for the use of the SCI Gateway for referrals, discharge summaries including prescribing information, and shorter waiting times for clinic appointments.

The researchers also conducted structured interviews with 16 patients and/or patient caregivers, who were all impressed by the clinic and pleased with their experience there.

These patients and caregivers said the time they spent with an experienced specialist nurse improved their knowledge about their allergies, gave them a greater feeling of control over their allergies and improved their quality of life as a result.

As consultations focused on practical ways to minimize the impact of these allergies on daily lives and cope with the anxieties raised by allergic symptoms, these patients also said they felt more supported and that they appreciated the convenience of the local clinic.

The local and familiar location of these clinics also made attendance easy, eliminating transportation problems. In fact, the researchers wrote, some patients indicated that they might not have attended the clinic if it would have been based in a hospital.

Further, patients were impressed by the short time that elapsed between the referral and their visit with the nurse, particularly because of the anxieties they felt about their allergies.

Patients said these consultations were helpful as well, considering the nurses’ expertise in allergies and in living with them, in addition to tests that were performed in the clinic with some results provided immediately.

These consultations, which patients said were longer than they had expected, enabled discussions that covered all the patients’ concerns, unlike consultations with general practitioners during which patients said they felt rushed.

Patients reported feeling happy with and confident in the care these nurses provided and felt as if they left these visits with a clear plan on how to manage their allergies daily, including autoinjector training and other practical tips in addition to their emotional needs.

The researchers also interviewed nine HCPs, all of whom were positive about the service and said these clinics addressed an existing gap. The referral process was straightforward, these respondents said, as communication with the nurses and post-discharge care were easy. The respondents also appreciated how the clinics were led by nurses with specialist knowledge.

These clinics did not reduce the workload for HCPs, the researchers continued, but they particularly met a need for young adults who lacked transition or adult allergy services in Edinburgh while providing accessibility due to their local presence.

Overall, the researchers concluded that the in-person and remote models of these nurse-led allergy clinics were acceptable, feasible and effective in providing care for patients with suspected or confirmed food allergy, eczema, allergic rhinitis and anaphylaxis, although their effectiveness should be confirmed with a formal randomized controlled trial.

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