A risk adjusted cost‐effectiveness analysis of alternative models of nurse involvement in obesity management in primary care

Abstract

Objective: Controlled evaluations are subject to uncertainty regarding their replication in the real world, particularly around systems of service provision. Using routinely collected data, we undertook a risk adjusted cost-effectiveness (RAC-E) analysis of alternative applied models of primary health care for the management of obese adult patients. Models were based on the reported level of involvement of practice nurses (registered or enrolled nurses working in general practice) in the provision of clinicalbased activities. Design and Methods: Linked, routinely collected clinical data describing clinical outcomes (weight, BMI, and obesity-related complications) and resource use (primary care, pharmaceutical, and hospital resource use) were collected. Potential confounders were controlled for using propensity weighted regression analyses. Results: Relative to low level involvement of practice nurses in the provision of clinical-based activities to obese patients, high level involvement was associated with lower costs and better outcomes (more patients losing weight, and larger mean reductions in BMI). Excluding hospital costs, high level practice nurse involvement was associated with slightly higher costs. Incrementally, the high level model gets one additional obese patient to lose weight at an additional cost of $6,741, and reduces mean BMI by an additional one point at an additional cost of $563 (upper 95% confidence interval $1,547). Conclusion: Converted to quality adjusted life year (QALY) gains, the results provide a strong indication that increased involvement of practice nurses in clinical activities is associated with additional health benefits that are achieved at reasonable additional cost. Dissemination activities and incentives are required to encourage general practices to better integrate practice nurses in the active provision of clinical services.

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

“…Training may range from two days (the TrueBlue study) to a university awarded postgraduate qualification with additional work experience (mental health nurse credential required to receive the MHNIP). Other RAC-E studies have shown that greater practice nurse involvement in the care of patients with diabetes and obesity is cost-effective [19,20]. Thus, in primary care settings where no specific framework for mental health training and support has been provided, practice nurse time might be better targeted towards diabetic or obese patient groups.…”

“…The Primary Care Services Improvement Project (PCSIP) was a retrospective observational study, which used RAC-E methods to assign general practices to models of care based on observed differences in practice nurse activity in the provision of clinical-based services. Three case studies were conducted [19,20], with this paper reporting on the depression case study.…”

The impact of maternal BMI, gestational weight gain, and breastfeeding on early childhood weight: Analysis of a statewide WIC dataset

“…Specifically, the focus of this research is the relationship between these variables among women and children who participate in the Wisconsin WIC program in order to provide evidence for future targeted interventions for at risk women and children to reduce risk of unhealthy weight and its sequalae. This study will help perinatal healthcare providers who have an opportunity to influence weight-related behaviors, including nutrition for the maternal-child dyad (Karnon et al 2013;Streuling et al 2010). As we better understand these modifiable factors and their contribution to weight-related risk to offspring, we can better plan interventions that can be delivered during pregnancy with the potential to influence multiple generations in a vulnerable population.…”

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

“…For the patient, general practice provides a reputable, convenient, familiar and accessible setting with the opportunity for longterm follow up and support. There is evidence that nurse-led programs are effective in providing risk assessment, patient education, counselling and obesity management in primary care (Counterweight Project Team 2008, 2012Wood et al 2008;Sargent et al 2012;Karnon et al 2013) and that patients report high levels of satisfaction with nurses providing chronic disease management (Halcomb et al 2015). However, international evidence suggests that the perceived self-efficacy and legitimacy of GPs and practice nurses in providing weight management care is impeded by a lack of obesity-specific training (Nolan et al 2012;Henderson 2015).…”