School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.
Department of Nutrition and Food Sciences, University of Vermont, Vermont, USA.
Nutr Diet. 2018 Feb;75(1):35-43. doi: 10.1111/1747-0080.12335. Epub 2017 Jan 24.
To compare the theoretical costs of best-practice weight management delivered by dietitians in a traditional, in-person setting compared to remote consultations delivered using eHealth technologies.
Using national guidelines, a framework was developed outlining dietitian-delivered weight management for in-person and eHealth delivery modes. This framework mapped one-on-one patient-dietitian consultations for an adult requiring active management (BMI ≥ 30 kg/m ) over a one-year period using both delivery modes. Resources required for both the dietitian and patient to implement each treatment mode were identified, with costs attributed for material, fixed, travel and personnel components. The resource costs were categorised as either establishment or recurring costs associated with the treatment of one patient.
Establishment costs were higher for eHealth compared to in-person costs ($1394.21 vs $90.05). Excluding establishment costs, the total (combined dietitian and patient) cost for one patient receiving best-practice weight management for 12 months was $560.59 for in-person delivery, compared to $389.78 for eHealth delivery. Compared to the eHealth mode, a higher proportion of the overall recurring delivery costs was attributed to the patient for the in-person mode (46.4% and 33.9%, respectively).
Although it is initially more expensive to establish an eHealth service mode, the overall reoccurring costs per patient for delivery of best-practice weight management were lower compared to the in-person mode. This theoretical cost evaluation establishes preliminary evidence to support alternative obesity management service models using eHealth technologies. Further research is required to determine the feasibility, efficacy and cost-effectiveness of these models within dietetic practice.
比较营养师在传统面对面环境中提供最佳实践体重管理的理论成本与使用电子健康技术进行远程咨询的成本。
使用国家指南，制定了一个框架，概述了营养师在面对面和电子健康两种模式下提供的体重管理。该框架映射了在一年时间内，使用两种交付模式对需要积极管理（BMI≥30kg/m ）的成年患者进行一对一的医患咨询。确定了营养师和患者在实施每种治疗模式时所需的资源，并为材料、固定、差旅和人员等方面的成本分配了费用。将资源成本分为与治疗一名患者相关的设立成本或经常性成本。
与面对面模式相比，电子健康模式的设立成本更高（1394.21 美元对 90.05 美元）。不包括设立成本，在 12 个月内接受最佳实践体重管理的一名患者的总（营养师和患者）成本为面对面模式 560.59 美元，电子健康模式 389.78 美元。与电子健康模式相比，面对面模式的患者承担了更高比例的总重复交付成本（分别为 46.4%和 33.9%）。
尽管最初建立电子健康服务模式的成本较高，但与面对面模式相比，最佳实践体重管理的每位患者的总体重复交付成本较低。本理论成本评估为使用电子健康技术提供替代肥胖管理服务模式提供了初步证据。需要进一步研究以确定这些模式在饮食实践中的可行性、疗效和成本效益。
