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An economic model was developed to estimate the cost of negative pressure wound therapy with instillation and dwelling of a topical wound solution vs control therapies. Economic model inputs were means derived from the results of a recently published systematic review and meta-analysis of 13 comparative studies of negative pressure wound therapy with instillation. Means across studies comprising complex acute and chronic wounds for negative pressure wound therapy-instillation vs control (negative pressure wound therapy without instillation, gauze dressings, or gentamicin polymethylmethacrylate beads) groups were 1.77 vs 2.69 operating room visits (P = .008) and 9.88 vs 21.80 therapy days (P = .02), respectively. These inputs plus hospital cost data were used to model costs for the United States, Germany, and the United Kingdom. For the United States, Germany, and United Kingdom, respectively, economic model estimates of total potential per patient savings were $33 338, €8467, and £5626 for negative pressure wound therapy-instillation group vs control, based on assumed number of OR visits during therapy, cost of therapy system, and length of therapy. Model results showed an overall potential cost-savings with negative pressure wound therapy-instillation vs control, based on fewer OR visits and shorter therapy duration as reported in the published systematic review and meta-analysis., (© 2021 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

Objective: To survey the interest of obstetrician-gynecologists in serving as primary care physicians and their perceived preparedness for that role from the view points of managed care plans and obstetrician-gynecologists., Methods: A sample of obstetrician-gynecologists was asked to describe their preferred physician roles in managed care plans. Managed care medical directors were asked to define the obstetrician-gynecologist's role in their health plans. The mailed survey questions focused on 1) obstetrician-gynecologists' interest in serving as primary care physicians and/or gatekeepers, 2) direct access to obstetrician-gynecologists, and 3) additional training needed to serve as primary care physicians., Results: Thirty-seven percent of obstetrician-gynecologists expressed little or no interest in serving as primary care physicians, and 37% had some or high interest. Fifty-six percent were not interested in serving as gatekeepers, and 45% believed that physicians in the specialty should not do so. Almost all believed women should be allowed direct access to obstetrician-gynecologists. Over half of the managed care plans allowed women to refer themselves to obstetrician-gynecologists, and one-third allowed these physicians to serve as primary care gatekeepers. Most plans believed that extensive additional training is needed for obstetrician-gynecologists to serve as gatekeepers, whereas 70% of specialists believed that little or no additional training is needed., Conclusion: Obstetrician-gynecologists do not all agree on their appropriate and preferred role as physicians in the managed care environment; 37% see themselves as primary care physicians, whereas 37% would rather act as consultative specialists. Nearly all, however, support direct access to obstetrician-gynecologists. Most (69.7%) believe that they are capable of serving as primary care gatekeepers with little or no additional training, but managed care plans believe otherwise.