More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

Autor: Jörgen Thorn, Robert Eggertsen, Lena Nordeman, Mikael Svensson, Lena Bornhöft, Maria E. H. Larsson
Rok vydání: 2019
Předmět:
Male
lcsh:Diseases of the musculoskeletal system
Sports medicine
Total cost
medicine.medical_treatment
Cost-Benefit Analysis
Nurses
Musculoskeletal disorders
0302 clinical medicine
Health care
Epidemiology
Medicine
Orthopedics and Sports Medicine
Musculoskeletal Diseases
Physiotherapy
health care economics and organizations
030222 orthopedics
Rehabilitation
Cost–benefit analysis
Health Care Costs
Middle Aged
Primary care
Treatment Outcome
Critical Pathways
Female
Quality-Adjusted Life Years
Research Article
Adult
medicine.medical_specialty
Adolescent
03 medical and health sciences
Young Adult
Quality of life (healthcare)
Rheumatology
General Practitioners
Humans
Aged
030203 arthritis & rheumatology
Sweden
Primary Health Care
business.industry
Patient Acceptance of Health Care
Triage
Physical Therapists
Physical therapy
Quality of Life
lcsh:RC925-935
business
Follow-Up Studies
Zdroj: BMC Musculoskeletal Disorders
BMC Musculoskeletal Disorders, Vol 20, Iss 1, Pp 1-9 (2019)
ISSN: 1471-2474
Popis: Background A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment. Methods Nurse-assessed patients with MSD (N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results. Results The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis. Conclusion From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings. Trial registration ClinicalTrials.gov NCT02218749. Registered August 18, 2014.
Databáze: OpenAIRE
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