将玻璃体腔内注射从医生转移到挪威一家三级医院的护士手中的成本后果。
Cost consequences of task-shifting intravitreal injections from physicians to nurses in a tertiary hospital in Norway.
机构信息
Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
出版信息
BMC Health Serv Res. 2023 Mar 8;23(1):229. doi: 10.1186/s12913-023-09186-0.
BACKGROUND
Anti-vascular endothelial growth factor is a medicine administered intravitreally by an injection to maintain visual acuity in patients with a variety of retinal diseases. The demand for this treatment has grown considerably in the westernized world the last two decades and will continue to increase due to an aging population. Because of the high volume, injections seize enormous resources and represent high costs for both hospitals and society. Task-shifting of injections from physicians to nurses may be a means to reduce such costs, however the magnitude of possible savings has been poorly investigated. To this end we investigated changes in the hospital costs per injection, six-year cost projections of physician- versus nurse-administered injections for a Norwegian tertiary hospital and we compared the societal costs per patient per year.
METHODS
Patients (n = 318) were randomized to either physician- or nurse administered injections, and data were prospectively collected. Hospital costs per injection were calculated as the sum of training costs, personnel time and running expenses. The number of injections for the years 2014 - 21 from a Norwegian tertiary hospital was combined with age group specific injection prevalence and population projections to calculate cost projections for 2022 - 27. Societal costs per patient were calculated as the sum of hospital costs, transport costs for patients, caregivers' use of time, costs of ophthalmology consultations and community-based homecare.
RESULTS
The hospital costs per injection were 5.5 € higher for physicians compared to nurses (281.6 € versus 276.1 €). Cost projections estimated an annual hospital saving of task-shifting of 48 921 € for 2022 - 27. Societal costs per patient did not differ significantly between the two groups (mean 4988 € vs 5418 €, p = 0.398).
CONCLUSION
Task-shifting of injections from physicians to nurses can reduce hospital costs and increase the flexibility of physician resources. The annual savings are modest, but increased demand for injections might increase future cost savings. To achieve future savings for society, organizing ophthalmology consultations and injections on the same day to reduce the number of visits might be a solution.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02359149 (09/02/2015).
背景
抗血管内皮生长因子是一种通过注射眼内给药的药物，用于维持各种视网膜疾病患者的视力。在过去的二十年中，这种治疗方法在西方世界的需求大幅增长，并且由于人口老龄化，这种需求还将继续增加。由于注射需求量大，注射占用了大量资源，给医院和社会带来了高昂的成本。将注射工作从医生转移到护士手中可能是降低这些成本的一种手段，但是可能节省的幅度还没有得到很好的研究。为此，我们调查了每针注射的医院成本变化，对挪威一家三级医院的医生和护士管理注射的六年成本预测，并比较了每位患者每年的社会成本。
方法
将（n=318）名患者随机分配至医生或护士管理的注射组，并前瞻性收集数据。每针注射的医院成本计算为培训成本、人员时间和运行费用的总和。将挪威一家三级医院 2014-21 年的注射次数与特定年龄组的注射流行率和人口预测相结合，计算 2022-27 年的成本预测。每位患者的社会成本计算为医院成本、患者交通成本、护理人员时间成本、眼科咨询费用和社区家庭护理费用的总和。
结果
与护士相比，医生的每针注射成本高出 5.5 欧元（281.6 欧元对 276.1 欧元）。成本预测估计，2022-27 年，将注射工作从医生转移到护士手中，每年可节省医院费用 48921 欧元。两组患者的社会成本无显著差异（平均 4988 欧元对 5418 欧元，p=0.398）。
结论
将注射工作从医生转移到护士手中可以降低医院成本并增加医生资源的灵活性。每年的节省额不大，但随着注射需求的增加，未来可能会节省更多成本。为了实现社会的未来节省，将眼科咨询和注射安排在同一天，以减少就诊次数，可能是一个解决方案。
试验注册
ClinicalTrials.gov NCT02359149（2015 年 9 月 2 日）。
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