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A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study.

Norman IJ, Coster S, McCrone P, Sibley A, Whittlesea C - BMC Health Serv Res (2010)

Bottom Line: There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care.No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers.The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.

View Article: PubMed Central - HTML - PubMed

Affiliation: King's College London, Division of Health and Social Care Research, London SE1 8WA, UK. ian.j.norman@kcl.ac.uk

ABSTRACT

Background: Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing.

Methods: A post-test control group experimental design was used to compare the treatment costs, clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing with a matched group of patients in receipt of independent prescribing from consultant psychiatrists. The sample comprised 45 patients in receipt of mental health nurse supplementary prescribing for a minimum of six months and a matched group (by age, gender, diagnosis, and chronicity) of patients prescribed for by psychiatrists.

Results: There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care. Total costs per patient for service use were 803 pounds higher for the nurse prescribers' group but this difference was not significant (95% confidence interval--1341 pounds to 3020 pounds).

Conclusions: No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers. The cost appraisal also showed that there was no significant difference in the costs of the two types of prescribing, although the pattern of resources used differed between patients in the two prescriber groups. The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.

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Sensitivity analysis: service costs for nurse and independent prescribers' groups as nurse prescriber caseload increases.
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Figure 1: Sensitivity analysis: service costs for nurse and independent prescribers' groups as nurse prescriber caseload increases.

Mentions: Figure 1 shows the impact on total service costs (excluding informal care) as the caseload (or number of patients prescribed for by the nurse) increases as a function of time. The effect of the increased number of patients reduces the unit cost of the intervention, but the figure shows that this has a modest effect on total costs. Even if numbers increased by 200% the costs would remain above those for the independent medical prescriber group, although the difference would not be significant.


A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study.

Norman IJ, Coster S, McCrone P, Sibley A, Whittlesea C - BMC Health Serv Res (2010)

Sensitivity analysis: service costs for nurse and independent prescribers' groups as nurse prescriber caseload increases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2820038&req=5

Figure 1: Sensitivity analysis: service costs for nurse and independent prescribers' groups as nurse prescriber caseload increases.
Mentions: Figure 1 shows the impact on total service costs (excluding informal care) as the caseload (or number of patients prescribed for by the nurse) increases as a function of time. The effect of the increased number of patients reduces the unit cost of the intervention, but the figure shows that this has a modest effect on total costs. Even if numbers increased by 200% the costs would remain above those for the independent medical prescriber group, although the difference would not be significant.

Bottom Line: There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care.No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers.The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.

View Article: PubMed Central - HTML - PubMed

Affiliation: King's College London, Division of Health and Social Care Research, London SE1 8WA, UK. ian.j.norman@kcl.ac.uk

ABSTRACT

Background: Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing.

Methods: A post-test control group experimental design was used to compare the treatment costs, clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing with a matched group of patients in receipt of independent prescribing from consultant psychiatrists. The sample comprised 45 patients in receipt of mental health nurse supplementary prescribing for a minimum of six months and a matched group (by age, gender, diagnosis, and chronicity) of patients prescribed for by psychiatrists.

Results: There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care. Total costs per patient for service use were 803 pounds higher for the nurse prescribers' group but this difference was not significant (95% confidence interval--1341 pounds to 3020 pounds).

Conclusions: No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers. The cost appraisal also showed that there was no significant difference in the costs of the two types of prescribing, although the pattern of resources used differed between patients in the two prescriber groups. The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.

Show MeSH