延長診間服務時間可降低健康方面的支出


  【24drs.com】根據2000-2008年間「美國醫療費用支出調查」30,714名病患的資料,在延長診間服務時間內接受常規健康照護者,就診次數、處方藥物、急診次數、住院等總花費降低超過10%。
  
  加州大學達維斯分校Sacramento醫學院健康政策與研究中心家庭與社區醫學系Anthony Jerant醫師等人在9月家庭醫學誌發表研究結果。
  
  作者們寫道,兩年研究期間內,病患報告了他們利用傍晚和週末時的診間服務情況,兩年的健康照護總費用比那些未曾在傍晚或週末就診者少,死亡率方面也無明顯不良影響。
  
  他們連續兩年探討了接受和未接受延長診間服務的病患,並比較了各組的健康照護使用與費用,他們也分析了2000- 2005年的回應資料,以確認至2006年的所有原因死亡率。
  
  在延長診間時間接受照護的病患,比較少就診、少用處方藥物、較少急診次數與住院,且相關花費降低。
  
  與沒有在延長時間接受照護組相比,在延長診間時間接受照護組的兩年總花費降低了10.4%(95%信心區間[CI],7.2% - 13.4%;P < .01)。
  
  校正社會人口統計學因素、醫療保險情況、以及醫療費用支出調查之年份等可能影響因素之後,再度進行分析,第2年時,在延長時間就診和明顯降低急診使用有關(就診次數降低1.9%;95% CI,0.8% - 3.7%;P = .04),但是住院方面則無。
  
  校正第2年急診與住院開支、或就診總次數與處方藥物數之後,這項關聯並未明顯降低。
  
  再加上校正處方花費,則減弱了此關聯,校正診間相關花費則更進一步減弱關聯性。
  
  到了2006年底,833名回應者(3.7%)死亡,包括了在兩年期間接受延長診間時間組的有191人(2.3%),以及未接受延長時間組的642人(4.0%)。
  
  在2000-2005年納入的病患中,死亡率和接受延長診間時間之間並無統計上的關聯(校正風險比1.11;95% CI,0.92 - 1.35;P = .28; n = 22,766)。
  
  作者們指出,開業的健康照護提供者延長服務時間更可以降低一般的照護成本,包括藥物費用降低、約診時間比較不會醫囑隨意檢查。
  
  作者們認為,這研究結果有助於意欲以相對簡單之方法確認這類實務的健康管理當局和政策制定者,這對健康照護之金融危機是個重要目標。
  此外,就處置立場來看,提供延長服務時間就診的病患,比較不會要求專利藥物和隨意檢查;後續探討這些和其他機轉的研究將會對此議題更有幫助。
  
  資料來源: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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