A cost-minimisation study of 1,001 NHS Direct users

作者：Lambert Rod^*; Fordham Richard; Large Shirley; Gaffney Brian

来源：BMC Health Services Research, 2013, 13(1): 300.

DOI：10.1186/1472-6963-13-300

Background: To determine financial and quality of life impact of patients calling the %26apos;0845%26apos; NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. %26lt;br%26gt;Methods: Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct%26apos;s telephone service using telephone survey results. 1,001 people contacting NHS Direct%26apos;s 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. %26lt;br%26gt;Results: Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p %26lt; 0.001). Per patient cost savings resulted from NHS Direct%26apos;s recommendation to attend A%26E (36.54); pound GP Practice (19.41); pound Walk-In Centre (49.85); pound Pharmacist (25.80); pound Dentist (2.35) pound and do nothing/treat at home (19.77) pound, while it was marginally more costly for 999 calls (3.33) pound. Overall an average per patient saving of 19.55 pound was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of 97,756,013 pound. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was %26apos;urgent%26apos; (p = 0.001) and those who said it was %26apos;non-urgent%26apos; (p = 0.045). Whilst both groups improved, self-classified %26apos;urgent%26apos; cases made greater health gains than those who said they were %26apos;non-urgent%26apos; (urgent by 21.5 points; non-urgent by 16.1 points). %26lt;br%26gt;Conclusions: The %26apos;0845%26apos; service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients%26apos; own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

• 出版日期2013-8-8