Peripatetic intravenous service for metabolic bone disease: case study in patient centred-care for new NHS.
OBJECTIVE
To develop a 'close to patient' peripatetic intravenous service (PIVS) for delivery of specialist osteoporosis care in a community setting without increasing cost and with a reduced carbon footprint.


METHODS
Cost and feasibility of a PIVS for intravenous (i.v.) bisphosphonate treatment were modelled using UK National Health Service costings and then tested in the field for 1 year. Average patient mileage to peripatetic sites was compared with mileage travelled if treated at the base hospital (current practice). The method of travel to hospital (current practice) or peripatetic sites (new study) was ascertained together with patients' preference for the new or the current system. Peripatetic sites were researched and those with suitable facilities selected. Data for fuel consumption were based on a usage of 1 litre per 14.5 km.


METHODS
The main outcome measure was cost comparison between hospital and peripatetic services. Others included patient satisfaction, miles saved, method of travel to the clinic and changes in CO(2) emissions.


RESULTS
Cost per patient, including drugs, lies between pound557 and pound622 annually for 1000 and 500 patients, respectively which is cost-neutral compared with hospital attendance. PIVS was rated more convenient by 98% of patients. Hospital transport was significantly reduced and the total monthly saving of 2000 miles has reduced CO(2) emission by 6072 kg p.a. No medical emergency occurred in 410 infusions.


CONCLUSIONS
PIVS is cost neutral compared with a conventional service, leads to a better patient experience, a significant cutback in hospital transport costs and a reduction of the NHS carbon footprint. However not all drugs may be suitable for this service: the area served was rural with large distances and poor public transport and mileage savings may not accrue in urban areas. Insurance was not included in the calculation of costs.
Davie
Michael
M
The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, UK. mike.davie@rjah.nhs.uk
Jeffreson
Paula
P
Jones
Teresa
T
Roberts
Tracey
T
Adekunle
Femi
F
Mitchell
Paul
P
D001336:Automobiles; D002244:Carbon; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000008:administration & dosage*; D004777:Environment; D005579:Fossil Fuels; D017048:Health Care Costs; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics; D010024:Osteoporosis / Q000188:drug therapy*; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D014187:Transportation of Patients / Q000191:economics / Q000458:organization & administration; D006113:United Kingdom
D004164:Diphosphonates; D005579:Fossil Fuels; D002244:Carbon