Vrije Universiteit Amsterdam, Faculty of Earth and Life Sciences, Institute of Health Sciences, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
Emerg Med J. 2012 Mar;29(3):192-6. doi: 10.1136/emj.2010.101949. Epub 2011 Mar 25.
Many patients visit the accident and emergency department (AED) on their own initiative, although their medical problem can be adequately treated by a general practitioner (GP). Objective To evaluate the cost-effectiveness of addition of a GP to the AED (new care method) in comparison with usual care (usual care method).
This study followed a before/after design. Patients attending the AED without a referral on weekdays from 10:00 to 17:00 were invited to participate. Main outcome measures were process time, patient satisfaction and number of correct diagnoses. Costs were measured from a societal perspective. Bootstrapping was used to estimate uncertainty around differences in costs and incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were presented.
Addition of a GP to the AED resulted in significantly lower process time, significantly higher patient satisfaction and no statistically significant difference in the number of correct diagnoses. Total costs per patient were €217 in the new care period and €288 in the usual care period (mean difference -€71, 95% CI -121 to -23). The cost-effectiveness analysis showed that the new care method was dominant (more effective, less expensive) in comparison with the usual care method for process time and patient satisfaction. The new care method was considered cost-effective in comparison with the usual care method for ceiling ratios between €0 and €1363 for the number of correct diagnoses.
The new care method consisting of addition of a GP to the AED is cost-effective in comparison with usual care for all outcome parameters measured.
尽管患者的医疗问题可以由全科医生（GP）充分治疗，但仍有许多患者自行前往急诊部（AED）就诊。目的：评估在 AED 增加 GP（新护理方法）与常规护理（常规护理方法）相比的成本效益。
本研究采用前后设计。邀请在工作日 10:00 至 17:00 期间无转介自行前往 AED 的患者参加。主要结局指标是过程时间、患者满意度和正确诊断的数量。从社会角度衡量成本。使用自举法估计成本和增量成本效益比差异的不确定性。呈现成本效益平面和可接受性曲线。
在 AED 增加 GP 可显著缩短就诊时间，显著提高患者满意度，且在正确诊断数量方面无统计学差异。新护理期每位患者的总成本为 217 欧元，常规护理期为 288 欧元（平均差异 -71 欧元，95%置信区间 -121 至 -23）。成本效益分析表明，与常规护理方法相比，新护理方法在就诊时间和患者满意度方面具有优势（更有效、更便宜）。与常规护理方法相比，新护理方法在正确诊断数量的上限比为 0 至 1363 欧元时被认为具有成本效益。
与常规护理相比，在 AED 增加 GP 的新护理方法在所有测量的结果参数方面都是具有成本效益的。
