Couch Anna G, Foo Jonathan, James Alicia M, Maloney Stephen, Williams Cylie M
1Peninsula Health, Community Health, Hastings Rd, Frankston, VIC 3199 Australia.
2Department of Physiotherapy, Monash University, McMahon's Rd, Frankston, VIC 3199 Australia.
J Foot Ankle Res. 2018 Jul 13;11:40. doi: 10.1186/s13047-018-0282-1. eCollection 2018.
In the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced.
This was a cost-description analysis, involving the calculation of costs associated with the development and implementation of a mentoring program to train podiatrists to become endorsed prescribers. Costs were calculated using the Ingredients Method and examined from the perspective of a public health service provider, and the individual learner podiatrist. Breakeven analysis compared the cost of training a podiatry prescriber for endorsement against the potential benefit (savings) made by averting complications of an infected foot ulcer. A sensitivity analysis was conducted to allow for uncertainty in the results of an economic evaluation.
Total start-up cost for the podiatry prescriber mentoring program was $13, 251. The total cost to train one learner podiatrist was $30, 087, distributed between the hospital $17, 046 and the individual learner $13, 041. In the setting studied, a podiatry prescriber must avert 0.40 major amputations arising from an infected foot ulcer through prescribing to recover the cost of training. If in-kind training costs are included, total cost increases to $50, 654, and the breakeven point shifts to 0.68 major amputations averted.
The economic benefits (savings) created by an endorsed prescribing podiatrist over their career in a public health service are likely to outweigh the costs to train a podiatrist to attain endorsement. Further research is required to help understand the effectiveness of podiatry prescribing in reducing diabetic foot related complications and the potential economic impact of podiatry prescribers on this health condition.
在糖尿病及高危患者的管理中，按时服用常规药物对于预防严重感染及降低下肢截肢风险至关重要。然而，在澳大利亚，仅有少数足病医生获得了处方权。本研究旨在确定制定并实施一项足病医生处方指导计划的相关成本，并将该计划的成本与所产生的潜在医疗保健节省费用进行比较。
这是一项成本描述分析，涉及计算为培训足病医生成为有处方权者而制定和实施指导计划的相关成本。成本采用成分法计算，并从公共卫生服务提供者和个体足病医生学员的角度进行审视。盈亏平衡分析将培训一名获得处方权的足病医生所需的成本与通过避免足部感染溃疡并发症所产生的潜在收益（节省费用）进行了比较。进行了敏感性分析，以考虑经济评估结果中的不确定性。
足病医生处方指导计划的总启动成本为13,251美元。培训一名足病医生学员的总成本为30,087美元，其中医院承担17,046美元，个体学员承担13,041美元。在所研究的环境中，一名足病医生必须通过开处方避免0.40例因足部感染溃疡导致的大截肢手术，才能收回培训成本。如果计入实物培训成本，总成本将增至50,654美元，盈亏平衡点将变为避免0.68例大截肢手术。
在公共卫生服务领域，一名获得处方权的足病医生在其职业生涯中所创造的经济效益（节省费用）可能超过培训一名足病医生以获得处方权的成本。需要进一步开展研究，以帮助了解足病医生开处方在减少糖尿病足相关并发症方面的有效性，以及足病医生开处方对这种健康状况的潜在经济影响。
