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A randomised trial comparing the cost effectiveness of different emergency department healthcare professionals in soft tissue injury management

McClellan, Carey Middleton; Cramp, Fiona; Benger, Jonathan Richard; McClellan, Carey; Cramp, Fiona (Alice); Benger, Jonathan; Powell, Jane

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Authors

Carey Middleton McClellan

Fiona Cramp

Jonathan Richard Benger

Carey McClellan

Fiona Cramp Fiona.Cramp@uwe.ac.uk
Professor in Long Term Conditions

Jonathan Benger

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Jane Powell Jane.Powell@uwe.ac.uk
Professor in Public Health Economics



Abstract

Objectives: To evaluate the cost effectiveness of soft tissue injury management by emergency nurse practitioners (ENPs) and extended scope physiotherapists (ESPs) compared with the routine care provided by doctors in an emergency department (ED). Design: Randomised, pragmatic trial of equivalence. Setting: A single ED in England. Participants:372 patients were randomised, 126 to the ESP group, 123 to the ENP group and 123 to the doctor group. Participants were adults (16 years and older) presenting to the ED with a peripheral soft tissue injury eligible for management by any of the three professional groups. Interventions: Patients were randomised to treatment by an ESP, ENP or routine care provided by doctors (of all grades). Main outcome measures: Economic costminimisation evaluation from a funder perspective of the National Health Service, England incorporating analysis of the direct, indirect and tangible costs of care in primary and secondary settings. Results: From a funder perspective in primary and secondary care, ESPs and ENPs are at best equivalent and could not cost less than routine care. Uncertainty in cost arises from ESPs and ENPs incurring greater indirect costs, such as those associated with follow-up appointments and subsequent primary care visits. Comparison from a funder perspective in secondary care, that is, considering those costs incurred in secondary care alone, demonstrates that ENPs are equivalent in cost to routine care, while ESPs are either equivalent or possibly cheaper than routine care. Conclusions: These results question the notion that training the healthcare workforce to undertake extensions of their role is generally cost effective. While the randomised trial indicated that the three professional groups have equivalent clinical outcomes, this economic analysis suggests that substitution of routine care with a predominantly ESP or ENP workforce could prove more expensive. Further research is required to understand the underlying reasons for this. The trial has been registered with ISRCTN-ISRCTN 70891354.

Citation

Benger, J. R., Cramp, F., McClellan, C. M., McClellan, C., Cramp, F. (., Powell, J., & Benger, J. (2013). A randomised trial comparing the cost effectiveness of different emergency department healthcare professionals in soft tissue injury management. BMJ Open, 3(1), https://doi.org/10.1136/bmjopen-2012-001116

Journal Article Type Article
Publication Date Feb 14, 2013
Deposit Date Jan 23, 2013
Publicly Available Date Mar 28, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 3
Issue 1
DOI https://doi.org/10.1136/bmjopen-2012-001116
Keywords physiotherapy, soft tissue injury management
Public URL https://uwe-repository.worktribe.com/output/936218
Publisher URL http://dx.doi.org/10.1136/bmjopen-2012-001116