护士主导与非专业教育者对初级保健中哮喘患者的支持：成本研究。

Nurse led versus lay educators support for those with asthma in primary care: a costing study.

机构信息

Institute for Applied Health Research/School of Health and Life Sciences Glasgow Caledonian University, Glasgow, UK.

出版信息

BMC Pulm Med. 2012 Sep 8;12:52. doi: 10.1186/1471-2466-12-52.

DOI:10.1186/1471-2466-12-52

PMID:22958541

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3503752/

Abstract

BACKGROUND

Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses.

METHODS

Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial.

RESULTS

One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events).The training costs for the lay-trainers were greater than nurses (£36 versus £18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses (£6 per patient versus £24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is £161, and £135 for lay-trainers (mean difference £25, [95% CI = -£97, £149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were £202 per patient for nurses versus £178 for lay-trainers, (mean difference £24, [95%CI = -£100, £147, p = 0.707]).

CONCLUSIONS

There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use.

摘要

背景

指南中提倡定期审查和支持哮喘自我管理。一项随机对照试验表明，当为患者提供由非专业培训师或执业护士提供的自我管理支持时，患者的非计划性医疗保健使用情况相似。

方法

在 RCT 之后，使用试验数据进行了成本研究，以说明两种策略下服务的交付成本以及对该试验中未计划的医疗保健（有效性衡量标准）的影响。

结果

一年的数据（n=418）显示，护士组有 29%（61/205）需要非计划性医疗保健（177 次事件），而非专业培训师组为 30.5%（65/213）（178 次事件）。非专业培训师的培训成本高于护士（每名患者分别为 36 英镑和 18 英镑，p<0.001），但非专业培训师的咨询费用低于护士（每名患者 6 英镑对 24 英镑，p<0.001）。如果考虑非计划性医疗保健的成本，那么护士的成本为 161 英镑，非专业培训师的成本为 135 英镑（平均差异为 25 英镑，[95%CI = -97 英镑，149 英镑，p = 0.681]）。护士的总费用（交付和非计划性医疗保健）为每名患者 202 英镑，而非专业培训师为 178 英镑（平均差异为 24 英镑，[95%CI = -100 英镑，147 英镑，p = 0.707]）。