title: Peripatetic intravenous service for metabolic bone disease: case study in patient centred-care for new NHS.
abstract: 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.
authors.affiliation: The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, UK. mike.davie@rjah.nhs.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Davie
authors.forename: Paula
authors.initials: P
authors.lastname: Jeffreson
authors.forename: Teresa
authors.initials: T
authors.lastname: Jones
authors.forename: Tracey
authors.initials: T
authors.lastname: Roberts
authors.forename: Femi
authors.initials: F
authors.lastname: Adekunle
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: 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
chemical_list: D004164:Diphosphonates; D005579:Fossil Fuels; D002244:Carbon