Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars

Background Reflective testing, i.e. interpreting, commenting on and, if necessary, adding tests in order to aid the diagnostic process in a meaningful and efficient manner, is an extra service provided by laboratory medicine. However, there have been no prospective randomized controlled trials investigating the value of reflective testing in patient management. Methods In this trial, primary care patients were randomly allocated to an intervention group, where general practitioners received laboratory tests results as requested as well as add-on test results with interpretative comments where considered appropriate by the laboratory specialist, or to a control group, where general practitioners only received the laboratory test results requested. Patients’ medical records were evaluated with a follow-up period of six months. For both groups, the primary outcome measures, i.e. both intended action and actual management action, were blindly assessed by an independent expert panel as adequate, neutral or inadequate. Results In 226 of the 270 cases (84%), reflective testing was considered to be useful for the patient. In the intervention group ( n = 148), actual management by the general practitioner was scored as adequate ( n = 104; 70%), neutral ( n = 29; 20%) or not adequate ( n = 15; 10%). In the control group ( n = 122), these numbers were 57 (47%), 37 (30%) and 28 (23%). This difference was statistically significant ( P < 0.001). Conclusion This randomized controlled trial showed a positive effect of reflective testing in primary care patients on the adequacy of their management, as documented in medical records.

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Incremental cost-effectiveness of a collaborative care intervention for panic disorder

Psychological Medicine ◽

10.1017/s0033291705006896 ◽

2006 ◽

Vol 36 (3) ◽

pp. 353-363 ◽

Cited By ~ 57

Author(s):

WAYNE KATON ◽

JOAN RUSSO ◽

CATHY SHERBOURNE ◽

MURRAY B. STEIN ◽

MICHELLE CRASKE ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Panic Disorder ◽

Incremental Cost ◽

Usual Care ◽

Moderate Increase ◽

Patient Costs ◽

Care Intervention ◽

Life Years ◽

Primary Care Patients

Background. Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment.Method. This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs).Results. Relative to usual care, intervention patients experienced 60·4 [95% confidence interval (CI) 42·9–77·9] more AFDs over a 12-month period. Total incremental out-patient costs were $492 higher (95% CI $236–747) in intervention versus usual care patients with a cost per additional AFD of $8.40 (95% CI $2.80–14.0) and a cost per QALY ranging from $14158 (95% CI $6791–21496) to $24776 (95% CI $11885–37618). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension.Conclusions. The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

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The Cost-Effectiveness of Screening Primary Care Patients for Depression

Annals of Internal Medicine ◽

10.7326/0003-4819-134-5-200103060-00003 ◽

2001 ◽

Vol 134 (5) ◽

pp. I-83

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Primary Care Patients ◽

The Cost

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Early detection of asthma and chronic obstructive pulmonary disease in primary care patients

Medicinski pregled ◽

10.2298/mpns1302046v ◽

2013 ◽

Vol 66 (1-2) ◽

pp. 46-52 ◽

Cited By ~ 4

Author(s):

Marija Vukoja ◽

Predrag Rebic ◽

Zorica Lazic ◽

Marija Mitic-Milikic ◽

Branislava Milenkovic ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Primary Care ◽

Pulmonary Disease ◽

General Practitioners ◽

Primary Care Physicians ◽

Smoking History ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Number Of Patients ◽

Primary Care Patients

Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95%CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465). Conclusion. A significant number of patients seen in the general practitioner?s office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.

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