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Acute management of fractures in primary care - a cost minimisation analysis

BACKGROUND: In Norway, primary healthcare has first-line responsibility for all medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care in hospitals. However, the cooperating municipalities of Bykle and Valle have X-ray facili...

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Autores principales: Vabo, Stein, Kjerstad, Egil, Hunskaar, Steinar, Steen, Knut, Brudvik, Christina, Morken, Tone
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668448/
https://www.ncbi.nlm.nih.gov/pubmed/37996824
http://dx.doi.org/10.1186/s12913-023-10297-x
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author Vabo, Stein
Kjerstad, Egil
Hunskaar, Steinar
Steen, Knut
Brudvik, Christina
Morken, Tone
author_facet Vabo, Stein
Kjerstad, Egil
Hunskaar, Steinar
Steen, Knut
Brudvik, Christina
Morken, Tone
author_sort Vabo, Stein
collection PubMed
description BACKGROUND: In Norway, primary healthcare has first-line responsibility for all medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care in hospitals. However, the cooperating municipalities of Bykle and Valle have X-ray facilities and handle minor fractures locally. The aim of this study was to estimate the costs of X-ray diagnosis and initial treatment of fractures at the local primary care centre compared with initial transport and treatment in hospital. METHODS: We conducted a cost minimisation analysis by comparing expected costs of initial examination with X-ray and treatment of patients with fractures or suspected fractures at two possible sites, in the local municipality or at the hospital. A cost minimisation analysis is an economic evaluation based on the assumption that the outcomes of the two treatment procedure regimens are equal. Costs were estimated in Euros (EUR) using 2021 mean exchange rates. RESULTS: In 2019, we identified a total of 403 patients with suspected fractures in the two municipalities. Among these, 12 patients bypassed the primary care system as they needed urgent hospital care. A total of 391 injured patients were assessed with X-ray at the primary health care centres, 382 received their initial treatment there, and nine were referred to hospital. In an alternative hospital model, without X-ray and treatment possibilities in the municipality, the 382 patients would have been sent directly to hospital for radiological imaging and treatment. The total cost was estimated at EUR 367,756 in the hospital model and at EUR 69,835 in the primary care model, a cost saving of EUR 297,921. CONCLUSION: Based on cost minimisation analysis, this study found that radiological diagnosis of suspected fractures and initial treatment of uncomplicated fractures in primary care cost substantially less than transport to and treatment in hospital.
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spelling pubmed-106684482023-11-23 Acute management of fractures in primary care - a cost minimisation analysis Vabo, Stein Kjerstad, Egil Hunskaar, Steinar Steen, Knut Brudvik, Christina Morken, Tone BMC Health Serv Res Research BACKGROUND: In Norway, primary healthcare has first-line responsibility for all medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care in hospitals. However, the cooperating municipalities of Bykle and Valle have X-ray facilities and handle minor fractures locally. The aim of this study was to estimate the costs of X-ray diagnosis and initial treatment of fractures at the local primary care centre compared with initial transport and treatment in hospital. METHODS: We conducted a cost minimisation analysis by comparing expected costs of initial examination with X-ray and treatment of patients with fractures or suspected fractures at two possible sites, in the local municipality or at the hospital. A cost minimisation analysis is an economic evaluation based on the assumption that the outcomes of the two treatment procedure regimens are equal. Costs were estimated in Euros (EUR) using 2021 mean exchange rates. RESULTS: In 2019, we identified a total of 403 patients with suspected fractures in the two municipalities. Among these, 12 patients bypassed the primary care system as they needed urgent hospital care. A total of 391 injured patients were assessed with X-ray at the primary health care centres, 382 received their initial treatment there, and nine were referred to hospital. In an alternative hospital model, without X-ray and treatment possibilities in the municipality, the 382 patients would have been sent directly to hospital for radiological imaging and treatment. The total cost was estimated at EUR 367,756 in the hospital model and at EUR 69,835 in the primary care model, a cost saving of EUR 297,921. CONCLUSION: Based on cost minimisation analysis, this study found that radiological diagnosis of suspected fractures and initial treatment of uncomplicated fractures in primary care cost substantially less than transport to and treatment in hospital. BioMed Central 2023-11-23 /pmc/articles/PMC10668448/ /pubmed/37996824 http://dx.doi.org/10.1186/s12913-023-10297-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Vabo, Stein
Kjerstad, Egil
Hunskaar, Steinar
Steen, Knut
Brudvik, Christina
Morken, Tone
Acute management of fractures in primary care - a cost minimisation analysis
title Acute management of fractures in primary care - a cost minimisation analysis
title_full Acute management of fractures in primary care - a cost minimisation analysis
title_fullStr Acute management of fractures in primary care - a cost minimisation analysis
title_full_unstemmed Acute management of fractures in primary care - a cost minimisation analysis
title_short Acute management of fractures in primary care - a cost minimisation analysis
title_sort acute management of fractures in primary care - a cost minimisation analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668448/
https://www.ncbi.nlm.nih.gov/pubmed/37996824
http://dx.doi.org/10.1186/s12913-023-10297-x
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