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BMC Health Services Research
Published in: BMC Health Services Research 1/2020

01-12-2020 | Care | Research article

An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial

Authors: Caitlin Fehily, Rod Ling, Andrew Searles, Kate Bartlem, John Wiggers, Rebecca Hodder, Andrew Wilson, Kim Colyvas, Jenny Bowman

Published in: BMC Health Services Research | Issue 1/2020

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Abstract

Background

Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the ‘specialist clinician’ model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery.

Methods

A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a ‘specialist preventive care clinician’ (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years.

Results

There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263–$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals.

Conclusions

The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits.

Trial registration

Appendix
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Metadata
Title
An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial
Authors
Caitlin Fehily
Rod Ling
Andrew Searles
Kate Bartlem
John Wiggers
Rebecca Hodder
Andrew Wilson
Kim Colyvas
Jenny Bowman
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-05204-7

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