title: The effect of an outpatient care on-demand-system on health status and costs in patients with COPD. A randomized trial.
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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Pulmonary Diseases, Isala, Zwolle, The Netherlands. Electronic address: f.f.berkhof@isala.nl.
authors.forename: Farida F
authors.initials: FF
authors.lastname: Berkhof
authors.affiliation: Department of Pulmonary Diseases, Isala, Zwolle, The Netherlands. Electronic address: annehesselink@hotmail.com.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Hesselink
authors.affiliation: Department of Pulmonary Diseases, Isala, Zwolle, The Netherlands. Electronic address: d.l.c.vaessen@isala.nl.
authors.forename: Dominique L C
authors.initials: DL
authors.lastname: Vaessen
authors.affiliation: Department of Pulmonary Diseases, Isala, Zwolle, The Netherlands. Electronic address: s.uil@tiscali.nl.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Uil
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, and Groningen Research Institute for Asthma and COPD GRIAC, Groningen, The Netherlands. Electronic address: h.a.m.kerstjens@umcg.nl.
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
authors.affiliation: Department of Pulmonary Diseases, Isala, Zwolle, The Netherlands. Electronic address: j.w.k.van.den.berg@isala.nl.
authors.forename: Jan W K
authors.initials: JW
authors.lastname: van den Berg
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D017046:Cost Savings; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
keywords: CCQ; Healthcare costs; On-demand-system; Resource-use