Davies A, Buxton M J, Patterson D L, Webster-King J
Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK.
Clin Lab Haematol. 2000 Feb;22(1):33-40. doi: 10.1046/j.1365-2257.2000.00282.x.
Anti-coagulated patients are monitored at regular intervals to ensure that their warfarin dosage is appropriate for their target International Normalized Ratio. The traditional setting for this monitoring has been the hospital clinic. Technological advances allow-- and with growing numbers of anti-coagulated patients, are leading to-- greater provision of monitoring clinics outside the hospital, at a more convenient location nearer patients' homes. This paper discusses the differences in organization between a hospital clinic and one set in the community (although provided by the hospital), and compares their costs. The comparison demonstrates the greater average cost per appointment in outreach of pound sterling 13.12 under current arrangements. Estimates are presented of incremental cost per appointment of pound sterling 3.93 and pound sterling 15.88 for a 10% increase in weekly patient numbers put through hospital and outreach clinics, respectively. Cost estimates are also presented for suggested alterations to hospital clinics that may reduce patient inconvenience, and the conditions under which outreach provision might be expanded at comparable cost to hospital provision are also examined.
接受抗凝治疗的患者需定期接受监测，以确保其华法林剂量适合目标国际标准化比值。传统上，此类监测是在医院门诊进行的。技术进步使得（而且随着接受抗凝治疗的患者数量不断增加，正促使）在医院外更方便、离患者家更近的地点开设更多监测诊所成为可能。本文讨论了医院门诊与社区诊所（尽管由医院提供）在组织方面的差异，并比较了它们的成本。比较结果表明，在当前安排下，外展诊所每次预约的平均成本更高，为13.12英镑。分别给出了估计值，即医院门诊和外展诊所每周就诊患者人数增加10%时，每次预约的增量成本分别为3.93英镑和15.88英镑。还给出了对医院门诊进行建议性改动的成本估计，这些改动可能会减少患者的不便之处，同时还研究了在可比成本下扩大外展服务的条件。
