Building evidence to support Best Practice Specialist Nursing Services for People with Parkinson’s disease in regional NSW: A retrospective analysis

Background and Aim:
Limited access to specialist services for people living in rural and regional Australia contributes to decreased health related quality of life. In contrast to people living with Parkinson’s disease in urban areas, disease management is poorer in rural and regional areas. With 93% of neurologists practising in major cities and no national approach to ensuring equitable access to neurology and specialist nursing services, living with Parkinson’s disease (PD) presents an enormous challenge for those in rural and regional locations.
In late 2017, Parkinson’s NSW partnered with nursing researchers from Charles Sturt University to undertake a staged project to build the case for the implementation of sustainable specialist Parkinson’s nurse services in rural and regional Australia. Findings from an integrative literature (2018) combined with evidence from a qualitative project (2019) demonstrated the benefits of the nurse-led model in the Mid North Coast Local Health District. This presentation reports a separate project undertaken to support health practice funding decisions enabling maintenance of the specialist PD nurse position in MNCLHD and implementation of further positions in rural and regional NSW. This retrospective analysis examined the cost effectiveness of the nurse led position related to; 1) length of hospital stay, and 2) frequency of admission/readmission to hospital by comparing service usage data and hospital costs pre and post the establishment of the specialist PD nurse position. Further, cost-benefit outcomes for the specialist nurse were also analysed.
Method:
A purposive sample was drawn from the population of patients admitted to Coffs Harbour hospital with a diagnosis of PD between the periods 1st January 2013 and 31st December 2014 and between 1st January 2016 and 31st December 2017. The sample includes a total of 128 PD patient records, two years before and after the PD nurse position was established. A multiple regression approach and cost-benefit analysis are used in the study.
Results:
Preliminary findings demonstrate reduction in hospital length of stay and re admissions post the establishment of the position. When combined with the detailed findings expected from this retrospective audit, the data will form the basis for the economic analysis essential to advocate for the implementation of specialist nurse positions in under-served rural and regional locations.
Take-home message:
Future economic evaluation studies in regional and rural areas designed prospectively are essential in determining total costs of PD both to society and the individual and supporting sustainability of specialist positions.