Diabetes specialist nurse telemedicine: admissions avoidance, costs and casemix

摘要

This study aimed to describe a diabetes specialist nurse (DSN) telemedicine advice service in a university hospital diabetes service in terms of the payment by results (PbR) tariff costs, potential admissions avoidance and casemix. The source, purpose, duration, outcome and patient age were recorded prospectively over 12 months for every patient-initiated, diabetes-related telephone consultation. In all, 5703 patient-initiated telephone consultations were recorded. Of these, 3459 (60.7%) involved insulin dose management for those receiving insulin therapy for longer than six months. In contrast, 530 (9.3%) consultations covered dose adjustment for individuals started on insulin therapy within the previous six months. A total of 235 (4.1 %) consultations involved managing insulin, food and fluid intake during intercurrent illness ('sick day' advice) -103 (1.8%) with ketonuria and 132 (2.3%) without ketonuria. Of these, only 17 required referral to their general practitioner for review for a hospital admission, representing 218 potentially avoided admissions over the study period. Individuals over 60 years of age accounted for 3610 (63.3%) consultations. The PbR tariff for each telephone consultation was pound23 (dollar37.66; european dollow 26.10), with an estimated annual cost of pound131 169 (dollar214781;european dollow 148 908). The national average unit costs (for 2008-09) for an emergency long-stay admission related to dysglycaemia range from pound846 (dollar1384; european dollow 961) to pound2634 (dollar4311; european dollow 2991), representing potential cost savings of between pound179 414 (dollar293 759;european dollow 203 715) and pound569 198 (dollar932 008; european dollow 646 400) for these 218 avoided admissions. In conclusion, DSNs provide hundreds of hours of telephone advice annually that improve ongoing diabetes care and represent a cost-effective method of reducing the number of acute hospital admissions.