Department of Integrated Care, Maastricht University Medical Centre, Maastricht, Netherlands.
Br J Gen Pract. 2010 Jan;60(570):e28-35. doi: 10.3399/bjgp10X482077.
As studies evaluating substitution of care have revealed only limited evidence on cost-effectiveness, a trial was conducted to evaluate nurse practitioners as a first point of contact in Dutch general practices.
To estimate costs of GP versus nurse practitioner consultations from practice and societal perspectives.
An economic evaluation was conducted alongside a randomised controlled trial between May and October 2006, wherein 12 nurse practitioners and 50 GPs working in 15 general practices (study practices) participated. Consultations by study practices were also compared with an external reference group, with 17 GPs working in five general practices without the involvement of nurse practitioners.
Direct costs within the healthcare sector included resource use, follow-up consultations, length of consultations, and salary costs. Costs outside the healthcare sector were productivity losses. Sensitivity analyses were performed.
Direct costs were lower for nurse practitioner consultations than for GP consultations at study practices. This was also the case for direct costs plus costs from a societal perspective for patients aged <65 years. Direct costs of consultations at study practices were lower than those of reference practices, while practices did not differ for direct costs plus costs from a societal perspective for patients aged <65 years. Cost differences are mainly caused by the differences in salary.
By involving nurse practitioners, substantial economic 'savings' could be used for redesigning primary care, to optimise the best skill mix, and to cover the full range of primary care activities.
由于评估替代护理的研究仅提供了有限的成本效益证据，因此进行了一项试验，以评估护士从业者作为荷兰普通诊所的第一联系点的效果。
从实践和社会角度评估全科医生与护士从业者咨询的成本。
2006 年 5 月至 10 月期间进行了一项经济评估，同时进行了一项随机对照试验，其中 12 名护士从业者和 50 名在 15 家普通诊所（研究诊所）工作的全科医生参与了试验。研究诊所的咨询还与一个外部参照组进行了比较，该组由 5 家普通诊所的 17 名全科医生组成，不涉及护士从业者。
医疗保健部门内的直接成本包括资源使用、随访咨询、咨询时间和工资成本。医疗保健部门以外的成本包括生产力损失。进行了敏感性分析。
研究诊所的护士从业者咨询的直接成本低于全科医生咨询，对于<65 岁的患者，从社会角度来看，直接成本加成本也是如此。研究诊所的咨询直接成本低于参照诊所，而对于<65 岁的患者，从社会角度来看，实践并不存在直接成本加成本的差异。成本差异主要是由于工资差异造成的。
通过引入护士从业者，可以利用大量的经济“节省”来重新设计初级保健，优化最佳技能组合，并涵盖初级保健的全部活动。
