Abstract
BackgroundClinical 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.MethodsA 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.ResultsThere 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.ConclusionsThe 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 registrationACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
Highlights
Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, such care is infrequently provided in routine consultations
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
A key component of the policy is referral to specialist chronic disease prevention services, with referrals directed to free, New South Wales (NSW) telephone-based services: Get Healthy Service and Quitline
Summary
Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, such care is infrequently provided in routine consultations. People with a mental illness are more likely to engage in chronic disease risk behaviours, including: tobacco smoking, insufficient nutrition, harmful alcohol consumption, and physical inactivity, compared to the general population [1,2,3,4,5]. Clinical practice guidelines recognise that mental health services provide an opportunity to deliver evidence-based ‘preventive care’: care that aims to address clients’ chronic disease risk behaviours (tobacco smoking, poor nutrition, harmful alcohol consumption, and physical inactivity) [13,14,15,16]; which may comprise three care elements: assessment, brief advice, and referral [17,18,19]. Referral to telephone-based chronic disease prevention services represents an important pillar of chronic disease prevention policy in New South Wales (NSW), Australia [20,21,22]
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