一项针对 1001 名 NHS Direct 用户的成本最小化研究。

A cost-minimisation study of 1,001 NHS Direct users.

机构信息

Health Economics Consulting, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.

出版信息

BMC Health Serv Res. 2013 Aug 8;13:300. doi: 10.1186/1472-6963-13-300.

DOI:10.1186/1472-6963-13-300

PMID:23927451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3751595/

Abstract

BACKGROUND

To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers.

METHODS

Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D.

RESULTS

Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points).

CONCLUSIONS

The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

摘要

背景

从 NHS 服务提供商的角度出发，确定拨打“0845”NHS Direct（NHS Direct）电话热线的患者的经济和生活质量影响。

方法

使用电话调查结果，对 NHS Direct 电话服务的全国调查中的重复队列测量进行成本最小化。2009 年，有 1001 人拨打 NHS Direct 的 0845 电话服务，并同意在 4-6 周后进行随访。在 NHS Direct 不可用时，对 NHS Direct 建议与患者首选的第一种替代方案之间的成本进行比较。分析还使用 EQ-5D 的视觉模拟量表考虑 NHS Direct 建议对生活质量的影响。

结果

观察到 NHS Direct 建议与患者首选的第一种替代方案之间存在显著的转诊模式差异（p < 0.001）。由于 NHS Direct 建议去 A&E（£36.54）；全科医生诊所（£19.41）；Walk-In 中心（£49.85）；药剂师（£25.80）；牙医（£2.35）和什么都不做/在家治疗（£19.77），因此 NHS Direct 的建议为每位患者节省了费用，而 999 电话的费用则略有增加（£3.33）。总体而言，发现每位患者平均节省了£19.55（与患者首选的第一种替代方案相比节省了 36%）。对于每年 500 万次 NHS Direct 电话咨询，这代表着每年节省 9775.6013 万英镑的成本。在那些认为自己的问题“紧急”（p = 0.001）和那些说问题“不紧急”（p = 0.045）的人之间，在基线和随访时观察到显著的生活质量差异。尽管两组都有所改善，但自我归类为“紧急”的病例比那些说自己“不紧急”的病例获得了更大的健康收益（紧急情况下为 21.5 分；非紧急情况下为 16.1 分）。