Cost-effectiveness of self-management in asthmatics: a 1-yr follow-up randomized, controlled trial

Gallefoss, Frode; Bakke, Per

doi:10.1183/09031936.01.17202060

Cited by 67 publications

(48 citation statements)

References 19 publications

(22 reference statements)

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“…The economical consequences of these interventions were inconclusive. Some of these studies reported a cost reduction [10,12,22,23], whilst others found that extra investments were needed to achieve a reduction in healthcare utilisation of the patients [24,25]. In these studies, however, the asthma nurse intervention was additional to the routine medical care.…”

Section: Discussionmentioning

confidence: 90%

“…Furthermore, maintenance treatment with inhaled corticosteroids has been shown to be cost effective [19][20][21]. The consequences of intervention by asthma nurses on healthcare costs are, however, inconclusive [10,12,[22][23][24][25]. This may be due to the fact that until now, care provided by an asthma nurse has always been additional to routine medical care.…”

Section: Introductionmentioning

confidence: 89%

“…Additional long term studies are needed to confirm the findings of this cost analysis of nurseled outpatient management in patients with more severe asthma. Previous studies have evaluated the effect of educational intervention by asthma nurses on the costs of management of asthma both in children and adults [10,12,[22][23][24][25]. The economical consequences of these interventions were inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches.A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches.There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n=14) versus 187(n=41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor9s visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care.Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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“…Previous studies have had relatively small sample sizes, selected cohorts, use of historical control subjects, or ignored the impact of such a program on healthcare costs (8)(9)(10)(11)(12)(13)(14)(15)(16). Some of these studies, but not all, have demonstrated a beneficial effect on healthcare use and asthma knowledge.…”

Section: Discussionmentioning

confidence: 99%

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

Castro

Zimmermann

Crocker

et al. 2003

Am J Respir Crit Care Med

125

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The largest portion of the cost for asthma healthcare is due to hospitalizations. Improved methods of healthcare delivery for patients with asthma are needed to prevent readmissions. From 1996 to 1999, 96 adult subjects (predominantly young African American women) hospitalized with an asthma exacerbation, who had a history of frequent healthcare use, were randomized to an asthma nurse specialist intervention (n ϭ 50) or a usual care group (n ϭ 46) for 6 months. Our aim was to decrease rates of readmissions within 6 months of hospital discharge, to reduce cost, and to improve health-related quality of life. Our results demonstrate a 60% reduction in total hospitalizations (31 readmissions in the intervention group and 71 in the control group, p ϭ 0.04), with no significant change in emergency department visits. Readmissions for asthma were reduced by 54% (21 vs. 42 in the control group; p ϭ 0.04). We found a marked reduction in lost work or school days: 246 versus 1,040 days in the control group (p ϭ 0.02). The intervention resulted in a substantial reduction in direct and indirect healthcare costs, saving $6,462 per patient (p ϭ 0.03). A brief intervention program focusing on high healthcare users with asthma can result in improved asthma control and reduced hospital use with substantial cost savings.

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“…Utilising a measure of corticosteroid inhaler compliance based on the ratio of dispensed to prescribed therapy over a 12-month period, the median compliance in the self-management group was 82% compared with 55% in the control group. This greater level of compliance was associated with an improved clinical outcome [11] and was cost-effective [17].…”

Section: Which Components Of the Plan Contribute To Its Efficacy?mentioning

confidence: 97%

The use of the self-management plan system of care in adult asthma

Holt¹,

Masoli

Beasley

2004

Primary Care Respiratory Journal

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KEYWORDS Asthma self-management plans;Asthma action plans; Asthma managementSummary The development of self-management plans arose as clinicians tried to design better methods by which they could deliver asthma care and reduce the significant mortality and morbidity associated with this disease. The basic principles that resulted have been widely endorsed, and self-management plans are now recommended in the long-term management of adult asthma. Self-management plans essentially focus on the early recognition of unstable or deteriorating asthma, by monitoring peak flow or symptoms. Through the use of written guidelines, patients are then able to determine when it is necessary to adjust therapy or obtain medical assistance.There is now convincing evidence that the use of self-management plans by patients with asthma leads to a marked reduction in morbidity and a reduced requirement for acute medical treatment including hospital admissions. Recent research has also clarified many of the different issues concerning their structure and implementation. In some respects the skill in the use of the asthma self-management plan system of care is the ability to modify the standard plans to meet the particular needs of the individual asthmatic patient, including their preferences.

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Cost-effectiveness of self-management in asthmatics: a 1-yr follow-up randomized, controlled trial

Cited by 67 publications

References 19 publications

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Asthma Intervention Program Prevents Readmissions in High Healthcare Users

The use of the self-management plan system of care in adult asthma

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