Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland.
Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland.
Int J Med Inform. 2018 Jul;115:120-127. doi: 10.1016/j.ijmedinf.2018.04.012. Epub 2018 Apr 30.
Type 2 diabetes (T2DM) is a major health concern in most regions. In addition to direct healthcare costs, diabetes causes many indirect costs that are often ignored in economic analyses. Patients' travel and time costs associated with the follow-up of T2DM patients have not been previously calculated systematically over an entire healthcare district. The aim of the study was to develop a georeferenced cost model that could be used to measure healthcare accessibility and patient travel and time costs in a sparsely populated healthcare district in Finland. Additionally, the model was used to test whether savings in the total costs of follow-up of T2DM patients are achieved by increasing self-monitoring and implementing electronic feedback practices between healthcare staff and patients.
Patient data for this study was obtained from the regional electronic patient database Mediatri. A georeferenced cost model of linear equations was developed with ESRI ArcGIS 10.3 software and ModelBuilder tool. The Model utilizes OD Cost Matrix method of network analysis to calculate optimal routes for primary-care follow-up visits.
In the study region of North Karelia, the average annual total costs of T2DM follow-up screening of HbA1c (9070 patients) conforming to the national clinical guidelines are 280 EUR/297 USD per patient. Combined travel and time costs are 21 percent of the total costs. Implementing self-monitoring for a half of the follow-up still within the guidelines, the average annual total costs of HbA1c screening could be reduced by 57 percent from 280 EUR/297 USD to 121 EUR/129 USD per patient.
Travel costs related to HbA1c screening of T2DM patients constitute a substantial cost item, the consideration of which in healthcare planning would enable the societal cost-efficiency of T2DM care to be improved. Even more savings in both travel costs and healthcare costs of T2DM can be achieved by utilizing more self-monitoring and electronic feedback practices. Additionally, the cost model composed in the study can be developed and expanded further to address other healthcare processes and patient groups.
2 型糖尿病（T2DM）是大多数地区的主要健康关注点。除了直接的医疗保健成本外，糖尿病还会导致许多间接成本，而这些成本在经济分析中往往被忽视。以前，尚未系统地计算过整个医疗区中 T2DM 患者随访相关的患者交通和时间成本。本研究的目的是开发一个地理参考成本模型，用于衡量芬兰一个人口稀少的医疗区的医疗保健可及性以及患者的交通和时间成本。此外，还使用该模型测试通过增加自我监测并在医疗保健人员和患者之间实施电子反馈实践，是否可以节省 T2DM 患者随访的总成本。
本研究的数据来自区域电子患者数据库 Mediatri。使用 ESRI ArcGIS 10.3 软件和 ModelBuilder 工具开发了一个线性方程的地理参考成本模型。该模型利用网络分析的 OD 成本矩阵方法计算初级保健随访的最佳路线。
在北卡累利阿地区，符合国家临床指南的 T2DM 随访筛查 HbA1c（9070 例患者）的平均年度总成本为每位患者 280 欧元/297 美元。交通和时间成本合计占总成本的 21%。如果在符合指南的情况下将一半的随访改为自我监测，则 HbA1c 筛查的平均年度总成本可从 280 欧元/297 美元降低至每位患者 121 欧元/129 美元，降低 57%。
T2DM 患者的 HbA1c 筛查相关交通成本是一项重要的成本项目，在医疗保健规划中考虑这些成本可以提高 T2DM 护理的社会成本效益。通过更多地利用自我监测和电子反馈实践，还可以进一步节省 T2DM 的交通成本和医疗保健成本。此外，本研究中构建的成本模型可以进一步开发和扩展，以解决其他医疗流程和患者群体的问题。
