The effect of an outpatient care on-demand-system on health status and costs in patients with COPD. A randomized trial

被引：9

作者：

Berkhof, Farida F. ^{[1
]}

Hesselink, Anne M. ^{[1
]}

Vaessen, Dominique L. C. ^{[1
]}

Uil, Steven M. ^{[1
]}

Kerstjens, Huib A. M. ^{[2
,3
]}

van den Berg, Jan W. K. ^{[1
]}

机构：

[1] Isala, Dept Pulm Dis, NL-8025 AB Zwolle, Netherlands

[2] Univ Groningen, Univ Med Ctr Groningen, Dept Pulm Dis, Groningen, Netherlands

[3] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma & COPD GRIAC, Groningen, Netherlands

来源：

RESPIRATORY MEDICINE | 2014年 / 108卷 / 08期

关键词：

CCQ; Healthcare costs; Resource-use; On-demand-system; OBSTRUCTIVE PULMONARY-DISEASE; INFLAMMATORY-BOWEL-DISEASE; QUALITY-OF-LIFE; SELF-MANAGEMENT PROGRAMS; ACCESS FOLLOW-UP; SHARED CARE; EXACERBATIONS; QUESTIONNAIRE; DIAGNOSIS;

D O I：

10.1016/j.rmed.2014.05.011

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Background: Traditionally, outpatient visits for COPD are fixed, pre-planned by the pulmonologist. This is not a patient centered method, nor, in times of increasing COPD prevalence and resource constraints, perhaps the optimal method. Objectives: This pilot study, determined the effect of an on-demand-system, patient initiated outpatient visits, on health status, COPD-related healthcare resource-use and costs. Methods: Patients were randomized between on-demand-system (n = 49) and usual care (n = 51), with a 2-year follow-up. Primary, health status was assessed with Clinical COPD Questionnaire (CCQ). Secondary endpoints were: St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36) scores, visits to general practitioners (GP), pulmonologists, and pulmonary nurse practitioners (PNP), exacerbations and total treatment costs from healthcare providers and healthcare insurance perspectives. Results: Participants had a mean FEV1 1.3 +/- 0.4 liters and were 69 9 years. CCQ total scores deteriorated in both groups, with no significant difference between them. CCQ symptom domain did show a significant and clinically relevant difference in favor of the on-demand-group, 0.4 +/- 0.21, CI95% - 0.87; -0.02, p = 0.04. Similar tendency was found for the SGRQ whereas results for SF-36 were inconsistent. Patients in the on-demand-group visited GP significantly less (p = 0.01), but PNP significantly more, p = 0.003. Visits to pulmonologists and exacerbations were equally frequent in both groups. Mean total costs per patient were lower in the on-demand-group in comparison with usual care, difference of (sic)-518 (-1993; 788) from healthcare provider and (sic)-458 (-2700; 1652) insurance perspective. Conclusions: The on-demand-system was comparable with usual care, had a cost-saving tendency, and can be instituted with confidence in the COPD outpatient care setting. (C) 2014 Elsevier Ltd. All rights reserved.

引用

页码：1163 / 1170

页数：8

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