社区心理健康服务中专科预防保健临床医生的经济评价：一项随机对照试验。
An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial.
机构信息
School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia.
Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
出版信息
BMC Health Serv Res. 2020 May 11;20(1):405. doi: 10.1186/s12913-020-05204-7.
BACKGROUND
Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the 'specialist clinician' model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery.
METHODS
A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a 'specialist preventive care clinician' (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years.
RESULTS
There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263-$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals.
CONCLUSIONS
The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits.
TRIAL REGISTRATION
ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
背景
临床实践指南和政策指导社区精神卫生服务提供预防保健以应对慢性病风险，但在常规咨询中很少提供此类保健。另一种护理模式是指定一名临床医生专门提供和提供额外咨询中的预防保健：“专科临床医生”模式。需要对护理模式进行经济评估，以确定遵守指南和政策的成本，并为实际服务提供决策提供信息。本研究是对专科临床医生模式的经济评估；旨在实现符合政策的预防保健服务。
方法
对一项随机对照试验中“专科预防保健临床医生”（职业治疗师）的增量成本、成本效益和预算影响进行了回顾性分析，参与者被随机分配接受常规护理；或常规护理加提供与专科临床医生的额外预防保健咨询。该研究的结果是客户接受两项免费基于电话的慢性病预防服务的转介。这是该服务所在地卫生区政策规定的关键护理服务成果。基础案例分析假设了精神卫生服务的成本视角。预算影响分析确定了在 5 年内为该社区精神卫生服务的所有客户实施该护理模式所需的年度预算。
结果
与常规护理相比，干预组参与者接受两项电话服务转介的比例从基线到随访有显著增加。增量成本效益比为每增加一次转介接受度增加 347 美元（置信区间：263-494 美元）。预计在 5 年内为所有潜在客户实施该护理模式的年度预算为 711,446 美元；导致 2616 次接受转介。
结论
该评估提供了有关精神卫生服务遵守政策目标的成本的关键信息，表明该护理模式的每位客户成本较低，同时增加了关键的预防保健服务成果。需要进一步建模来进一步探讨其经济效益。
试验注册
ACTRN12616001519448。2016 年 11 月 3 日注册，https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709。
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