Kamps A W A, Roorda R J, Kimpen J L L, Overgoor-van de Groes A W, van Helsdingen-Peek L C J A M, Brand P L P
Dept of Paediatrics, Isala Klinieken, Zwolle, The Netherlands.
Eur Respir J. 2004 Feb;23(2):304-9. doi: 10.1183/09031936.03.00052203.
The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches. A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches. There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n = 14) versus 187(n = 41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor's visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care. Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.
哮喘给医疗利用和成本带来的沉重负担使得有必要对管理方法进行经济学评估。作者先前证明，护士主导的儿童哮喘门诊管理的疗效与儿科医生管理相当，现在报告这两种管理方法的医疗利用情况和成本。共有74名新转诊的哮喘儿童被随机分配给儿科医生或哮喘护士进行为期1年的随访。记录了两种管理方法的医疗利用情况并计算了相关成本。除了与患者接触的总时间外，医疗利用情况没有显著差异（分别由儿科医生和哮喘护士随访的患者，接触时间为136（n = 14）分钟和187（n = 41）分钟）。医疗部门内的成本以护士主导的护理方式降低了7.2%。成本的降低完全归因于门诊就诊成本降低了17.5%。即使随访时间是医生就诊时间的两倍，护士主导的护理似乎也能节省成本。与传统医疗护理相比，护士主导的儿童哮喘门诊管理的总体医疗成本（医疗部门内外）低4.1%。护士主导的儿童哮喘门诊管理的成本低于儿科医生的医疗护理成本。
