Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs.
The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches. A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches. There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n = 14) versus 187(n = 41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor's visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care. Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.
Kamps
A W A
AW
Dept of Paediatrics, Isala Klinieken, Zwolle, The Netherlands. a.kamps@zonnet.nl
Roorda
R J
RJ
Kimpen
J L L
JL
Overgoor-van de Groes
A W
AW
van Helsdingen-Peek
L C J A M
LC
Brand
P L P
PL
D000293:Adolescent; D001249:Asthma / Q000191:economics / Q000453:epidemiology / Q000451:nursing*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000191:economics*; D006801:Humans; D008297:Male; D009720:Nurse Clinicians / Q000191:economics* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D013548:Sweden; D014600:Utilization Review / Q000706:statistics & numerical data