Cost effectiveness of providing nurse led annual asthma reviews by telephonevs face to face: a randomised controlled trial in UK primary care

Abstract

Background:

Telephone consultations offer an efficient and effective option for the routine review of adults with symptomatic asthma. [Pinnock et al, BMJ 2003;326:477–9]

Objective:

To compare the cost-effectiveness of nurse-led reviews undertaken by telephone with face-to face reviews.

Methods:

Cost effectiveness analysis based on a 3 month randomised controlled trial of telephone vs face-to-face reviews for adults with asthma in 4 UK general practices. Data on use of direct healthcare resources (primary / secondary care contacts and drug use) were obtained from the GP records

Results:

278 asthmatics were randomised to surgery (S: n=141) or telephone (T: n=137) review. 101 (74%) asthmatics in the telephone group were reviewed vs 68 (48%) in the surgery group (p<0.001). Telephone consultations were significantly shorter (mean duration T: 11.19 (SD 4.79) vs S: 21.87 (SD 6.85) minutes (p<0.001) Healthcare costs per patient over 3 months were similar (S: £59.22 (SD 66.00) vs T: £64.20 (SD 73.15) p=0.551) Total cost, based on unit costs for nurse clinic consultations in 2000/1 (www.pssru_library@ukc.ac.uk) plus the cost of telephone calls (www.BT.com) of providing 101 telephone and 68 face-to-face reviews was similar (T: £724.20 vs S: £697.60) but mean healthcare cost per consultation achieved was less in the telephone arm (T: £10.65 vs S: £6.91)

Conclusion:

Telephone consultations enabled a greater proportion of asthma patients to be reviewed (risk difference=26%) with cost savings to the NHS. This mode of delivering care is, therefore, a dominant strategy which not only improves access but reduces cost per consultation