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An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial.
- Source :
- BMC Health Services Research; 5/11/2020, Vol. 20 Issue 1, p1-16, 16p, 1 Diagram, 4 Charts, 2 Graphs
- Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Trial Registration: </bold>ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709. [ABSTRACT FROM AUTHOR]
- Subjects :
- COMMUNITY mental health services
OCCUPATIONAL therapists
MENTAL health services
MENTAL health policy
EVALUATORS
PREVENTIVE health services
TELEPHONES
PREVENTION of chronic diseases
RESEARCH
RESEARCH methodology
RETROSPECTIVE studies
EVALUATION research
MEDICAL cooperation
OCCUPATIONAL therapy
COMPARATIVE studies
RANDOMIZED controlled trials
COST effectiveness
MEDICAL referrals
RESEARCH funding
MENTAL illness
Subjects
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 20
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Health Services Research
- Publication Type :
- Academic Journal
- Accession number :
- 143152401
- Full Text :
- https://doi.org/10.1186/s12913-020-05204-7