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Randomized Controlled Trial
. 2014 Aug;108(8):1163-70.
doi: 10.1016/j.rmed.2014.05.011. Epub 2014 Jun 3.

The effect of an outpatient care on-demand-system on health status and costs in patients with COPD. A randomized trial

Farida F Berkhof  1 , Anne M Hesselink  2 , Dominique L C Vaessen  3 , Steven M Uil  4 , Huib A M Kerstjens  5 , Jan W K van den Berg  6
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Free article
Randomized Controlled Trial

The effect of an outpatient care on-demand-system on health status and costs in patients with COPD. A randomized trial

Farida F Berkhof et al. Respir Med. 2014 Aug.
Free article

Abstract

Background: Traditionally, outpatient visits for COPD are fixed, pre-planned by the pulmonologist. This is not a patient centered method, nor, in times of increasing COPD prevalence and resource constraints, perhaps the optimal method.

Objectives: This pilot study, determined the effect of an on-demand-system, patient initiated outpatient visits, on health status, COPD-related healthcare resource-use and costs.

Methods: Patients were randomized between on-demand-system (n = 49) and usual care (n = 51), with a 2-year follow-up. Primary, health status was assessed with Clinical COPD Questionnaire (CCQ). Secondary endpoints were: St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36) scores, visits to general practitioners (GP), pulmonologists, and pulmonary nurse practitioners (PNP), exacerbations and total treatment costs from healthcare providers and healthcare insurance perspectives.

Results: Participants had a mean FEV(1) 1.3 ± 0.4 liters and were 69 ± 9 years. CCQ total scores deteriorated in both groups, with no significant difference between them. CCQ symptom domain did show a significant and clinically relevant difference in favor of the on-demand-group, -0.4 ± 0.21, CI95% -0.87; -0.02, p = 0.04. Similar tendency was found for the SGRQ whereas results for SF-36 were inconsistent. Patients in the on-demand-group visited GP significantly less (p = 0.01), but PNP significantly more, p = 0.003. Visits to pulmonologists and exacerbations were equally frequent in both groups. Mean total costs per patient were lower in the on-demand-group in comparison with usual care, difference of €-518 (-1993; 788) from healthcare provider and €-458 (-2700; 1652) insurance perspective.

Conclusions: The on-demand-system was comparable with usual care, had a cost-saving tendency, and can be instituted with confidence in the COPD outpatient care setting.

Keywords: CCQ; Healthcare costs; On-demand-system; Resource-use.

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