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In the field of healthcare, the intersection of health economics and leadership is of paramount importance to ensure quality care in resource-intensive environments. I recently attended a primary healthcare conference after working as a registered nurse in the community for the past year. This experience has broadened my understanding of health economics and nurse-led clinic implementation. To evaluate the economic benefit of the intervention within the article, The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial,' I will employ the Critical Appraisal Skills Programme (CASP) tool.

(Q1) Was a well-defined question posed?

The authors Ndosi et al., (2014) of the research paper posed a well-defined question, aiming to evaluate the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA). They approached the research work with a clear purpose to determine the clinical as well as economic impact of NLC within the context of managing patients with rheumatoid arthritis (Ndosi et al., 2014). This entailed comparing NLC to traditional rheumatologist-led care (RLC) while accounting for costs and consequences. The authors also specified the economic perspectives from which the evaluation would be conducted, particularly focusing on the National Health Service (NHS) and healthcare perspectives. This explicitly laid out the scope of their investigation, emphasizing the economic consequences of the intervention (Ndosi et al., 2014). A major potential to evaluate both the long-term effectiveness and cost-efficiency of NLC was provided by the research time horizon of 52 weeks. This precise formulation of the study question offers a solid basis for evaluating the financial advantages and real-world applications of NLC in treating RA patients.

(Q2) Was a comprehensive description of the competing alternatives given?

Understanding the dynamics and constituent parts of the interventions required an in-depth overview of the competing alternatives, NLC and RLC, which was provided in the research article. Nurse-care was presented as a patient-centered approach to healthcare, with nurse practitioners carrying out a range of tasks individually or in collaboration with other multidisciplinary teams (Lopatina et al., 2021). The responsibilities of NLC included evaluating the progression of the disease, managing medications, monitoring therapy effectiveness, providing patient education and psychological support (Bala et al., 2018). The NLC practitioners operated within extended time slots, ensuring a holistic approach to patient care (Lopatina et al., 2021). This was compared to the standard RLC, which involved similar components within a shorter consultation time, requiring 15 minutes to address patients' needs. This detailed comparison enabled a clear understanding of the structural differences between the two models of care.

  1. Were all important and relevant resources required, and health outcome costs for each alternative identified, measured in appropriate units and valued credibly?

In this research article, the author Ndosi et al., (2014) evaluated both NLC and RLC in terms of resources. It considered the number of healthcare professionals involved, their experience, and the allocation of consultation time. This assessment enabled a comparison between the two care models and ensured that all pertinent and necessary resources were present (Ndosi et al., 2014). Secondly, the study employed appropriate units for measuring health outcomes. The disease activity score (DAS28), a commonly used metric in the management of rheumatoid arthritis, was used to measure disease activity (Greenmyer et al., 2020). The use of DAS28 as an outcome metric allows for a meaningful comparison of NLC and RLC effectiveness (Greenmyer et al., 2020). In addition, the study employed quality-adjusted life-years (QALY), a commonly used measurement in health economics, to measure the effect of interventions on the general health of the patients. Lastly, the research article provided a credible valuation of the related expenses. It considered the economic perspective of the NHS and healthcare, ensuring that the cost analysis was appropriate for the environment in which the interventions were evaluated. The inclusion of opportunity costs, a significant component in economic evaluations, increased the reliability of the findings.

(Q4) Discuss the applicability of the evidence to the local context.

Although the study's evidence provides insightful information about the efficiency and affordability of NLC, its applicability in the particular setting should be critically examined. The findings of the study indicate that NLC is non-inferior to RLC in managing RA patients (Ndosi et al., 2014). It draws attention to the possible therapeutic advantages of NLC, especially with regard to disease-specific outcomes like DAS28. So, it can be said that this data evidence can be valuable for the healthcare practitioners and policymakers of the UK, as it suggests that NLC could be a suitable alternative for managing RA patients (Ndosi et al., 2014). However, the limitation of the article lies in its relatively short follow-up period, which is limited to 52 weeks. RA is a chronic condition that often requires long-term management and care (Radu and Bungau, 2021). The study's 52-week timeframe may not be sufficient to assess the full spectrum of outcomes that can arise from managing RA patients with NLC (Ndosi et al., 2014). Moreover, while the research evidence supports the clinical effectiveness and potential cost-effectiveness of NLC, its application in the local context should be approached with consideration of broader health policy and resource factors. So, I believe, it is necessary to analyze whether the local infrastructure, staffing, and patient population are conducive to implementing NLC successfully.

(Q5) "Authentic leadership is grounded in positive psychology, it is regarded as a way of leading ethically and truthfully and it holds the promise of leveraging healthier, happier and productive workplaces".

This specific statement underscores the profound impact of authentic leadership on the healthcare environment. The fundamental factor of authentic leadership entails more than just being genuine and sincere; it also entails fostering a culture of trust, empowerment, and ethical decision-making (Raso, 2019). In a complex healthcare environment, authenticity is indispensable. Active listening, transparency, empathy, and leading a positive example are all characteristics of authentic leadership as a community nurse (Specchia et al., 2021). It entails creating a supportive work environment in which coworkers feel respected and empowered. Authenticity aids in the development of trust between healthcare personnel and patients in a field where decisions can have life-changing implications (Raso, 2019). Apart from this, by reducing stress and fostering a sense of belonging among the team members, it can be said that authentic leadership contributes to healthier workplaces (Specchia et al., 2021). As a result, it can result in better patient care as well as improved outcomes in the healthcare settings. Moreover, a culture of continuous learning and adaptation is also promoted by the factor authenticity, which is crucial in an ever-evolving healthcare landscape (Specchia et al., 2021). By embodying these principles, I shall aim to create a work environment that is not only ethically grounded but also a source of motivation and well-being for both colleagues and patients.

Therefore, this study improved my understanding of health economics in healthcare decision-making and stressed the importance of well-defined research topics, resource consideration, and authentic leadership in challenging healthcare settings for quality care.


Bala, S.V., Forslind, K., Fridlund, B., Samuelson, K., Svensson, B. and Hagell, P., 2018. Person‐centred care in nurse‐led outpatient rheumatology clinics: Conceptualization and initial development of a measurement instrument. Musculoskeletal care, 16(2), pp.287-295.

Greenmyer, J.R., Stacy, J.M., Sahmoun, A.E., Beal, J.R. and Diri, E., 2020. DAS28‐CRP cutoffs for high disease activity and remission are lower than DAS28‐ESR in rheumatoid arthritis. ACR Open Rheumatology, 2(9), pp.507-511.

Lopatina, E., Marshall, D. A., Le Clercq, S. A., Noseworthy, T. W., Suter, E., De la Rossa Jaimes, C., ... and Barber, C. E., 2021. Nurse-led care for stable patients with rheumatoid arthritis: quality of care in routine practice compared to the traditional rheumatologist-led model. Rheumatology and Therapy, 8, 1263-1285.

Ndosi, M., Lewis, M., Hale, C., Quinn, H., Ryan, S., Emery, P., Bird, H. and Hill, J., 2014. The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Annals Of the Rheumatic Diseases, 73(11), pp.1975-1982. annrheumdis-2013-203403

Radu, A.F. and Bungau, S.G., 2021. Management of rheumatoid arthritis: an overview. Cells, 10(11), p.2857.

Raso, R., 2019. Be you! Authentic leadership. Nursing Management, 50(5), pp.18-25. 10.1097/01.NUMA.0000557619.96942.50

Specchia, M.L., Cozzolino, M.R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W. and Damiani, G., 2021. Leadership styles and nurses’ job satisfaction. Results of a systematic review. International Journal of Environmental Research and Public Health18(4), p.1552.

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