初级保健护士教育外展以增加结核病病例检出率和改善呼吸护理的成本效益：一项随机试验的经济评估。

Cost-effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial.

机构信息

Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.

出版信息

Trop Med Int Health. 2010 Mar;15(3):277-86. doi: 10.1111/j.1365-3156.2009.02455.x. Epub 2010 Jan 11.

DOI:10.1111/j.1365-3156.2009.02455.x

PMID:20070633

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses.

METHODS

Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Practical Approach to Lung Health in South Africa (PALSA), comprised educational outreach based on syndromic clinical practice guidelines for tuberculosis, asthma, chronic obstructive pulmonary disease, pneumonia and other respiratory diseases. The study included 1999 patients aged 15 or over with cough or difficult breathing, attending 40 primary care clinics staffed by nurses in the Free State province. They were interviewed at first presentation, and 1856 (93%) were interviewed 3 months later.

RESULTS

The intervention increased the tuberculosis case detection rate by 2.2% and increased the proportion of patients appropriately managed (that is, diagnosed with tuberculosis or prescribed an inhaled corticosteroid for asthma or referred with indicators of severe disease) by 10%. It costs the health service $68 more for each extra patient diagnosed with tuberculosis and $15 more for every extra patient appropriately managed. Analyses were most sensitive to assumptions about how long training was effective for and to inclusion of household and tuberculosis treatment costs.

CONCLUSION

This educational outreach method was more effective and more costly than usual training in improving tuberculosis, asthma and urgent respiratory care. The extra cost of increasing tuberculosis case detection was comparable to current costs of passive case detection. The syndromic approach increased cost-effectiveness by also improving care of other conditions. This educational intervention was sustainable, reaching thousands of health workers and hundreds of clinics since the trial.

摘要

目的

评估南非护士开展教育外展干预以改善初级呼吸护理的成本效益。

方法

采用实用的基于群组的随机对照试验，同时进行个体患者数据分析。干预措施为实用的南非肺部健康方法（PALSA），包括基于结核病、哮喘、慢性阻塞性肺疾病、肺炎和其他呼吸系统疾病的综合征临床实践指南的教育外展。该研究纳入了自由州省 40 个由护士管理的初级保健诊所中 1999 名年龄在 15 岁及以上、有咳嗽或呼吸困难症状的患者。他们在首次就诊时接受了访谈，其中 1856 名（93%）在 3 个月后接受了访谈。

结果

干预措施使结核病的检出率提高了 2.2%，使更多的患者得到了适当的管理（即被诊断为结核病或开具了吸入性皮质类固醇治疗哮喘，或因严重疾病指标而被转诊），比例提高了 10%。每增加一个被诊断为结核病的患者，卫生服务部门的成本增加 68 美元；每增加一个得到适当治疗的患者，成本增加 15 美元。分析结果对培训效果的假设以及对家庭和结核病治疗成本的纳入最为敏感。