An advanced practice physiotherapy clinic in paediatric orthopaedics: A cost minimisation analysis

Article type: Research Article

Authors: Ó Mír, Marie^{a; b; *} | Rokicki, Slawa^c | Lennon, Olive^b | O’ Toole, Patrick O.^d | Desmeules, François^e | O’Sullivan, Cliona^b

Affiliations: [a] Physiotherapy Department, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland | [b] UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Ireland | [c] Geary Institute for Public Policy, University College Dublin, Ireland | [d] Orthopaedic Department, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland | [e] School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada

Correspondence: [*] Corresponding author: Marie Ó Mír, Clinical Specialist Physiotherapist, Physiotherapy Department, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland. Tel.: +353 87 2066497; E-mail: [email protected].

Abstract: PURPOSE:Advanced Practice Physiotherapy (APP) in paediatric orthopaedics is an effective adjunct to traditional consultant-led clinics, improving patient access to outpatient services, and reducing both waiting lists and times. However there has been no published economic evaluation of a paediatric orthopaedic APP service. This study performs a cost analysis, utilising a cost minimisation approach, comparing an APP Clinic in Paediatric Orthopaedics with usual care, from a health care perspective. METHODS:Data on all patients managed by the APP clinic for one calendar year were collected and outcomes and associated costs were calculated, including follow-up care. These costs were compared to the estimated costs of the usual care pathway, an Orthopaedic Consultant Elective Clinic (OCEC) and incremental savings per patient was calculated. RESULTS:A total of 534 patients attended the APP clinic for initial assessment during the calendar year 2017. The unit cost of a new appintment with the APP clinic is € 32.46 in comparison with € 56.98 for a new appointment in the OCEC. Our results demonstrate an incremental per patient saving of € 24.51 in favour of the APP clinic. Sensitivity analysis demonstrates that the cost savings obtained hold consistent in all cases, varying from € 23.13 to € 29.67 per patient in favour of the APP clinic pathway. This represents a cost saving of 43% for the APP Pathway over that of usual care. CONCLUSION(S):This is the first study to perform an economic analysis of the APP role in paediatric orthopaedics and demonstrates that an APP clinic for non-complex paediatric orthopaedic patients is substantially less costly than usual care.

Keywords: Advanced practice physiotherapy, cost minimisation, economic evaluation, paediatric orthopaedics

DOI: 10.3233/PPR-190137

Journal: Physiotherapy Practice and Research, vol. 40, no. 2, pp. 155-165, 2019