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The effect of an outpatient care on-demand-system on health status and costs in patients with COPD. A randomized trial.
- Source :
-
Respiratory medicine [Respir Med] 2014 Aug; Vol. 108 (8), pp. 1163-70. Date of Electronic Publication: 2014 Jun 03. - Publication Year :
- 2014
-
Abstract
- 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.<br />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.<br />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.<br />Results: Participants had a mean FEV(1) 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 €-518 (-1993; 788) from healthcare provider and €-458 (-2700; 1652) insurance perspective.<br />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.<br /> (Copyright © 2014 Elsevier Ltd. All rights reserved.)
- Subjects :
- Aged
Ambulatory Care economics
Cost Savings
Female
Forced Expiratory Volume physiology
Health Status
Humans
Male
Netherlands
Patient Acceptance of Health Care statistics & numerical data
Pilot Projects
Prospective Studies
Pulmonary Disease, Chronic Obstructive economics
Pulmonary Disease, Chronic Obstructive physiopathology
Treatment Outcome
Vital Capacity physiology
Ambulatory Care methods
Pulmonary Disease, Chronic Obstructive therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1532-3064
- Volume :
- 108
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Respiratory medicine
- Publication Type :
- Academic Journal
- Accession number :
- 24931900
- Full Text :
- https://doi.org/10.1016/j.rmed.2014.05.011