A cost-consequence analysis comparing patient travel, outreach, and telehealth clinic models for a specialist diabetes service to Indigenous people in Queensland

Abstract

Introduction The delivery of specialist health services to people living in Indigenous communities is an important challenge. Specialist diabetes outpatient clinics may be delivered via a patient travelling to a metropolitan hospital, during an outreach clinic, or by telehealth. The aim of this study was to compare the costs and consequences of different service models for delivering specialist diabetes clinics for a remote Indigenous community. Method Patient travel, outreach and telehealth clinic models were compared using a cost-consequence analysis principles. The setting was Cunnamulla, a remote Indigenous community in Western Queensland. Costs were calculated by quantifying the staff resources and travel costs for each clinic model. Costs were reported in Australian dollars and reported from the health service perspective. Results The marginal cost per patient for each clinic were $692 for patient travel, $482 for the outreach and $284 for telehealth. If a patient travel appointment was replaced with telehealth, approximately $517 in costs for patient travel reimbursement would be avoided. While replacing an entire outreach clinic with a telehealth clinic would reduce costs by approximately $3961. Conclusion The marginal cost of patient travel to a metropolitan clinic and outreach clinic appointments was greater than telehealth. Telehealth is unlikely to completely replace the need for patient travel or outreach clinics. However, replacing a proportion of these appointments with telehealth may reduce the overall costs of providing specialist diabetes care in remote communities. Telehealth may have advantages beyond economic as it reduces the time away from usual activities for both the patient and endocrinologist.

Does the Choice Between a Telehealth and an In-Person Appointment Change Patient Attendance?

“…This may improve the efficiency of clinics as reduced FTA rates lead to a more productive clinic, with a lower marginal cost per patient attendance. A previous cost analysis of a specialist clinic at the same hospital with similar staffing requirements estimated the average cost of a patient attending at AU$284 for an eight-patient clinic; however, if only five attend, the average cost per patient increases to AU$404, 13 demonstrating that even a small reduction in FTA events could have positive impacts not only for patients and clinicians but also the institution.…”

Why telehealth does not always save money for the health system

“…attending an appointment. (Smith et al , 2003; Snoswell et al , 2019b). For clinicians, the benefits in terms of reduced time and travel are especially noticeable when care is normally provided through outreach services (Snoswell et al , 2019b; Tousignant et al , 2015).…”

“…(Smith et al , 2003; Snoswell et al , 2019b). For clinicians, the benefits in terms of reduced time and travel are especially noticeable when care is normally provided through outreach services (Snoswell et al , 2019b; Tousignant et al , 2015). Additional benefits are increased service efficiencies (Azarmina and Wallace, 2005; Bauer et al , 2019), possible waitlist reduction and avoidance of unnecessary referrals (Caffery et al , 2016; Snoswell et al , 2016).…”

“…Additional benefits are increased service efficiencies (Azarmina and Wallace, 2005; Bauer et al , 2019), possible waitlist reduction and avoidance of unnecessary referrals (Caffery et al , 2016; Snoswell et al , 2016). The use of telehealth may also contribute to more culturally appropriate care (Snoswell et al , 2019b; Caffery et al , 2018) with improved social and emotional well-being for patients (Caffery et al , 2017). It has also been proposed that telehealth helps reduce professional and social isolation (Schopp et al , 2005; Moffatt and Eley, 2010).…”

A New Dimension of Health Care: The Benefits, Limitations and Implications of Virtual Medicine

“…Since the implementation of virtual health care practices, hospitals have been able to substantially cut down on costs for both patients and physicians 41 . The benefits of virtual medicine are two-fold: it allows health care workers to be more efficient as time-intensive face-to-face meetings can be addressed virtually, and allows citizens to access lower-cost services 41 . A study conducted in 2017 found that 80.7% of patients experienced a reduction in travel costs due to the Table 2 Common examples of remote patient monitoring technologies.…”