Is the provision of general medical services by non-medical health professionals cost-effective?

Conference:

SAPC ASM 2018 - London

Talk Code:

4D.2

Presenter:

Bethany Anthony

Co-authors:

Miss Bethany Anthony1, Dr Alun Surgey2, Dr Julia Hiscock2, Professor Nefyn Williams 3 , Dr Joanna Charles4.

Author institutions:

1 School of Healthcare Sciences, Bangor University, 2 North Wales Centre for Primary Care Research, Bangor University , 3 Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool 4 Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University,

Problem

Although previous systematic reviews have found that nurses and pharmacists can provide equivalent, or in some instances, higher quality of care compared with general practitioners (GPs) in primary care, there is a lack of economic evidence for this role substitution. Given the knowledge gap, the aims of this systematic review was to review economic evaluations of allied health professionals such as pharmacists, physiotherapists and occupational therapists providing general medical services instead of GPs.

Approach

A systematic review of the literature of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as ‘the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional’. A comprehensive search was performed in OVID Medline, CINAHL, Cochrane Library, NICE, and the Centre for Reviews and Dissemination (DARE & NHS EED databases). The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

Findings

Six studies were included in the review out of 10,261 initial studies identified by the review. Three were cost-minimisation analyses, two were cost-utility analyses and one was a cost-effectiveness analysis. Of the three economic evaluations exploring the cost-effectiveness of nurses substituting for GPs, two studies (a cost-minimisation analysis and a cost-utility analysis) found nurse-led care to be cost-effective. The third study assessing nurse-led care (a cost-effectiveness analysis) concluded that the nurse-led interventions assessed would not be deemed cost-effective in the UK at the current NICE cost-effectiveness threshold of £20-30,000 per quality adjusted life year (QALY). Both of the economic evaluations (a cost-minimisation analysis and a cost-utility analysis) exploring the cost-effectiveness of pharmacists substituting for GPs reported higher costs for pharmacist-led care compared with standard GP care. The sixth economic evaluation included in the review (a cost-minimisation analysis), compared a community health practitioner (CHP) services model of care with a no-CHP services model of care, whereby equivalent care was delivered by physicians. The study concluded that the CHP services model of care was cost-effective.

Consequences

To our knowledge, this is the first review of economic evaluations exploring the economic impact of role substitution of allied health professionals in primary care. This review draws attention to the severe lack of economic evidence exploring role substitution in primary care, especially for other groups of allied health professionals such as physiotherapists and occupational therapists. The key issue for policy is whether role substitution works in practice and whether it is effective and suitable to staff and patients. Role substitution is a rapidly emerging development in primary care; therefore, future economic evaluations are needed to determine the cost-effectiveness of allied health professionals taking on roles traditionally completed by the GP.

Submitted by:

Bethany Anthony

Funding acknowledgement:

Health and Care Research Wales