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General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care, 2019, Anthony

Discussion in 'BioMedical ME/CFS Research' started by Andy, Apr 25, 2019.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Paywall, https://bjgp.org/content/early/2019/04/22/bjgp19X702425
    Currently not available via Sci-hub.
     
    ladycatlover, Hutan, Skycloud and 4 others like this.
  2. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    I sometimes wonder if getting other people that do some of the things a doctor does ends up being more expensive.

    For example if my GP wants to give me an injection I see the GP who then explains about the nurse giving the injection, he then writes it up and informs the nurse, I see the receptionist to arrange another appointment, then see the nurse on another day, when the GP could have done the injection in the time it took to set the additional process in motion.

    If it was a course of injections it might be different, but as a one off it must be more expensive.
     
    Last edited: Apr 25, 2019
  3. Mithriel

    Mithriel Senior Member (Voting Rights)

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    I think what this is about is having what are called nurse practitioners. For instance I see a nurse every 4 months to check my diabetes. If my medication needs changed she will check with the doctor and send me a prescription so I only need to consult a doctor if something major happens. In hospitals there are nurses trained to do admissions and some who are there to help and advice junior doctors. When these doctors start on a ward the good ones have always relied on the expertise of nurses who have been involved with a particular speciality, say orthopaedics for many years.

    I would rather see a nurse with detailed knowledge of my condition than a doctor who once heard about it years ago in a medical lecture. MS nurses do good work and there have been ME nurses but ousted by psychologists.

    Maybe we will have a specialist nurse (who actually knows something!) in every hospital.
     
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  4. JemPD

    JemPD Senior Member (Voting Rights)

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    wow wouldnt that be great!
     
  5. Trish

    Trish Moderator Staff Member

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    Now on sci-hub:
    https://sci-hub.se/https://doi.org/10.3399/bjgp19X702425

    They only managed to find 6 studies to include, and the main conclusion seems to be that more studies are needed.

    Here's their summary:

    The nurse led CFS one was this, which looks like it's the FINE trial cost benefit paper:

    Richardson G, Epstein D, Chew-Graham C, Weardon et al. Cost-effectiveness of supported self-management for CFS/ME patients in primary care. BMC Fam Pract 2013; 14: 12

    It's fascinating and concerning that Chew-Graham and Weardon have themselves stated that neither supportive listening nor the mix of CBT/GET they call pragmatic rehabilitation (PR) is either effective or cost effective, yet they still push PR on the basis that patients want something (even if it's useless).

    @dave30th, given your current correspondence over Chew-Graham's claims of the costs of MUS, this surely scuppers her inclusion of ME in her MUS/IAPT ideas.
     
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