Nurse telephone consultation for out-of-hours primary care can save money through reduced ER admissions, surgery attendance and GP home visits
- Raftery, James
OBJECTIVE
To estimate costs and savings associated with the nurse telephone consultation service for out-of-hours primary care.
SETTING
A general practice cooperative with 55 GPs serving 97,000 registered patients in Wiltshire, England.
METHOD
Cost analysis from a National Health Service perspective of a randomized controlled trial.
LITERATURE REVIEW
No explicit strategy; 18 references.
PARTICIPANTS
All patients contacting the service (or about whom the service was contacted) between January 1997 and January 1998.
MAIN INTERVENTION
An out-of-hours nurse telephone consultation using decision support software.
OUTCOME MEASURE
The number of deaths observed within 7 days of a call was compared for patients managed by nurses alone with those involving a physician. Costs and savings to the NHS during the trial year were compared. Direct costs included staff and training costs; technical and managerial support; and capital costs. The savings included reduced emergency room admissions (based on the national average cost of an inpatient day); house calls by physicians; and surgery attendance (travel costs and the opportunity cost of a physician's time at £14 per consultation).
MAIN RESULTS
People managed by nurse consultation were less likely to be admitted to the hospital; to have short stays if admitted; to require a home visit; or attend surgery. The nurse consultation service was associated with a net savings of approximately £13,000 (£94,000 savings; £81,000 costs). Sensitivity analysis was performed (results range from net savings of −£86,000 to +£132,000). The break even point for the service required a reduction of 138 emergency room admissions for the year, without taking into consideration the savings associated with reduced surgery attendance and house calls.
AUTHORS' CONCLUSIONS
The greatest savings came from fewer emergency room admissions. The study did not assess long-term effects of the service on costs or patient outcomes. The results may not apply in situations where GPs are paid on a fee-for-service basis, but provide a ballpark estimate of potential savings in capitated systems.