Cost effectiveness of community leg ulcer clinics: randomised controlled trial
Cost effectiveness of community leg ulcer clinics: randomised controlled trial
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DOI：
10.1136/bmj.316.7143.1487
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发表时间：
1998-05-16
影响因子：
105.7
通讯作者：
Brooker, CGD
中科院分区：
文献类型：
--
作者：
Morrell, CJ;Walters, SJ;Brooker, CGD
目的：确定使用四层加压包扎的社区腿部溃疡诊所与地区护士提供的常规护理的相对成本效益。设计：随机对照试验，随访 1 年。设置：特伦特四个信托机构的 8 个社区研究诊所受试者：233 名静脉性腿部溃疡患者随机分配到干预组 (120) 或对照组 (113)。干预措施：每周在腿部溃疡诊所（诊所）进行四层绷带治疗组）或由地区护理服务机构在家进行常规护理（对照组）。主要结果指标：溃疡完全愈合的时间、患者健康状况和溃疡复发。还监测了对护理、服务使用和个人费用的满意度。结果：在整个 12 个月的随访中，临床组患者的溃疡往往比对照组患者愈合得更快（对数等级 P = 0.03）。 12 周时，临床组中有 34% 的患者痊愈，而对照组只有 24% 的患者痊愈。干预组与对照组相比，溃疡粗初始愈合率为1.45（95%置信区间1.04至2.03），各组间健康状况无显着差异。诊所组的平均 NHS 总费用为每年 878.06 英镑，对照组为 859.34 英镑（P = 0.89）。结论：基于社区的腿部溃疡诊所配备经过培训的护士，使用四层包扎比传统的家庭治疗更有效。这一优势只需少量的额外成本即可实现，并且如果使用某些服务配置，则可以降低成本。
Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses.Design: Randomised controlled trial with 1 year of follow up.Setting: Eight community based research clinics in four trusts in TrentSubjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group.Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group).Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored.Results: The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P = 0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03), No significant differences were found between the groups in health status. Mean total NHS costs were pound 878.06 per year for the clinic group and pound 859.34 for the control (P = 0.89).Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used.