Maastricht University Medical Centre, The Netherlands.
J Adv Nurs. 2012 Jun;68(6):1224-34. doi: 10.1111/j.1365-2648.2011.05797.x. Epub 2011 Oct 17.
To evaluate the cost-effectiveness of an intervention substituting physicians with nurse specialists.
Increasing populations of people with diabetes in most Western countries require creative solutions that give high-quality chronic care while controlling costs. Instigating nurse specialists as a substitute for physicians yields positive results in this area. Research about such interventions in a hospital-based setting is limited.
This paper is a report of a study of a randomized, non-blinded clinical trial including people with diabetes mellitus types 1 and 2. In the intervention group nurse specialists were the central carers, providing care that conformed to a preset protocol. Patients were included between 2004 and 2007. Costs, quality of life and adverse events were measured, cost-effect ratios and incremental cost-effect ratios were calculated based on health-resource utilization rates, corresponding market prices and national tariffs from 2007.
Health related quality of life scores did not differ significantly between the control and the intervention group. In the intervention group, fewer patients were hospitalized and fewer side effects from drugs were reported compared to controls. Nurse specialists as central care givers generated a modest reduction in costs per quality adjusted life year gained compared to usual care.
Nurse specialists give diabetes care that is similar to care provided by physicians in terms of quality of life and economic value. Instigating a nurse specialist as central carer yields opportunities to generate cost savings. Developing interventions which also focus on prevention of complications is recommended when aiming for long-term organisational cost savings.
评估以护士专家替代医生的干预措施的成本效益。
大多数西方国家的糖尿病患者人数不断增加，需要创造性的解决方案，在控制成本的同时提供高质量的慢性病护理。在这方面，倡导护士专家作为医生的替代者可以取得积极的结果。在医院环境中进行此类干预的研究有限。
本文是一项随机、非盲临床试验的报告，该试验纳入了 1 型和 2 型糖尿病患者。在干预组中，护士专家是主要护理人员，提供符合预设方案的护理。患者于 2004 年至 2007 年期间入组。测量了成本、生活质量和不良事件，根据 2007 年的卫生资源利用率、相应的市场价格和国家费率计算了成本效益比和增量成本效益比。
健康相关生活质量评分在对照组和干预组之间没有显著差异。与对照组相比，干预组住院患者较少，药物不良反应报告也较少。与常规护理相比，护士专家作为主要护理人员可适度降低每获得一个质量调整生命年的成本。
护士专家提供的糖尿病护理在生活质量和经济价值方面与医生提供的护理相似。倡导护士专家作为主要护理人员可以节省成本。当旨在实现长期组织成本节约时，建议开发也侧重于预防并发症的干预措施。
