延长诊间服务时间可降低健康方面的支出


  【24drs.com】根据2000-2008年间「美国医疗费用支出调查」30,714名病患的资料,在延长诊间服务时间内接受常规健康照护者,就诊次数、处方药物、急诊次数、住院等总花费降低超过10%。
  
  加州大学达维斯分校Sacramento医学院健康政策与研究中心家庭与社区医学系Anthony Jerant医师等人在9月家庭医学志发表研究结果。
  
  作者们写道,两年研究期间内,病患报告了他们利用傍晚和周末时的诊间服务情况,两年的健康照护总费用比那些未曾在傍晚或周末就诊者少,死亡率方面也无明显不良影响。
  
  他们连续两年探讨了接受和未接受延长诊间服务的病患,并比较了各组的健康照护使用与费用,他们也分析了2000- 2005年的回应资料,以确认至2006年的所有原因死亡率。
  
  在延长诊间时间接受照护的病患,比较少就诊、少用处方药物、较少急诊次数与住院,且相关花费降低。
  
  与没有在延长时间接受照护组相比,在延长诊间时间接受照护组的两年总花费降低了10.4%(95%信心区间[CI],7.2% - 13.4%;P < .01)。
  
  校正社会人口统计学因素、医疗保险情况、以及医疗费用支出调查之年份等可能影响因素之后,再度进行分析,第2年时,在延长时间就诊和明显降低急诊使用有关(就诊次数降低1.9%;95% CI,0.8% - 3.7%;P = .04),但是住院方面则无。
  
  校正第2年急诊与住院开支、或就诊总次数与处方药物数之后,这项关联并未明显降低。
  
  再加上校正处方花费,则减弱了此关联,校正诊间相关花费则更进一步减弱关联性。
  
  到了2006年底,833名回应者(3.7%)死亡,包括了在两年期间接受延长诊间时间组的有191人(2.3%),以及未接受延长时间组的642人(4.0%)。
  
  在2000-2005年纳入的病患中,死亡率和接受延长诊间时间之间并无统计上的关联(校正风险比1.11;95% CI,0.92 - 1.35;P = .28; n = 22,766)。
  
  作者们指出,开业的健康照护提供者延长服务时间更可以降低一般的照护成本,包括药物费用降低、约诊时间比较不会医嘱随意检查。
  
  作者们认为,这研究结果有助于意欲以相对简单之方法确认这类实务的健康管理当局和政策制定者,这对健康照护之金融危机是个重要目标。
  此外,就处置立场来看,提供延长服务时间就诊的病患,比较不会要求专利药物和随意检查;后续探讨这些和其它机转的研究将会对此议题更有帮助。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6942&x_classno=0&x_chkdelpoint=Y
  

Extended Office Hours Linked to Lower Health Expenditures

By Troy Brown
Medscape Medical News

September 10, 2012 — Patients with access to regular healthcare that included extended office hours had less use of and more than 10% lower total expenditures for office visits, prescription medications, emergency department visits, and hospitalizations, according to data from 30,714 patients surveyed for the Medical Expenditure Panel Survey between 2000 and 2008.

Anthony Jerant, MD, a professor of family medicine from the Department of Family and Community Medicine at the Center for Healthcare Policy and Research at the University of California, Davis, School of Medicine in Sacramento, and colleagues report their findings in the September issue of the Annals of Family Medicine.

"Patients reporting in both study years that their usual source of care offered evening and weekend hours had lower year 2 total health care expenditures than those consistently reporting no evening and weekend access, without apparent adverse effects on mortality," the authors write.

They looked at data for patients who reported access or no access to extended hours by their usual source of care in 2 consecutive years and compared use of healthcare and health expenditures for year 2 for both groups. They also analyzed data for respondents enrolled in 2000 to 2005 to determine all-cause mortality through 2006.

Patients with access to care during extended hours reported less use and lower associated expenditures for office visits, prescription medications, emergency department visits, and hospitalizations.

Total health expenditures for year 2 were 10.4% lower (95% confidence interval [CI], 7.2% - 13.4%; P < .01) in the group with access to extended hours compared with the group without access to extended hours.

Additional analyses were performed after adjusting for potential confounders including sociodemographic factors, medical insurance status, and Medical Expenditures Panel Survey panel year. Access to extended hours was associated with significantly lower emergency department use (1.9% fewer visits; 95% CI, 0.8% - 3.7%; P = .04) during year 2, but not hospitalizations.

This association was not significantly reduced by adjustment for year 2 emergency department and inpatient spending or for total number of office visits and number of prescription drugs.

Additional adjustment for prescription spending attenuated this association, and adjustment for office-related expenditures attenuated it even further.

By the end of 2006, 833 respondents (3.7%) had died: 191 (2.3%) of patients with access to extended hours during both years and 642 (4.0%) of patients without extended access for both years.

There was no statistical association between mortality and access to extended hours among patients who were enrolled in the 2000 to 2005 panels (adjusted hazard ratio, 1.11; 95% CI, 0.92 - 1.35; P = .28; n = 22,766).

The authors note that healthcare providers who work in practices that offer extended hours may be more inclined toward cost-conscious care in general, including the use of lower-cost (eg, generic) medications and less ordering of discretionary testing during office appointments.

"This finding may be useful to health administrators and policy makers interested in relatively simple ways of identifying such practices — a seemingly important aim given the health care financing crisis. Additionally, or alternatively, practices offering extended access may attract patients less likely, from a dispositional standpoint, to request brand name medications and discretionary testing. Studies designed to examine these and other mechanisms would be helpful," the authors write.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2012;10:388-395.

    
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