Inpatient multidisciplinary care of patients with active rheumatoid arthritis has been shown to be clinically effective in a number of studies in both the UK and North America, but it is unfortunately expensive because of high fixed costs such as hospital overheads and ward running costs. Multidisciplinary care comprises several elements including bed rest, withdrawal from domestic pressures, medication, education and physical therapy, but the individual contribution of each element to the overall clinical benefit remains uncertain. Day care, by eliminating some of the high fixed costs and overheads yet preserving all of the clinical elements of inpatient care, could be a more efficient method of managing patients with active rheumatoid arthritis. The original work described in this thesis addresses this issue. A pilot study of day-patient versus inpatient care was performed on twenty patients. This confirmed the acceptability of day-patient care and the practicality of the trial design. It also provided some preliminary economic data which suggested that day care may be substantially cheaper (40%) than conventional inpatient care. The pilot study was not powered to address the question of whether clinical outcome of day-patient therapy was equivalent to inpatient care. A larger prospective randomised clinical and economic evaluation of 118 patients was therefore undertaken. The aim was to test the hypothesis that the clinical outcome of inpatient and day care management of patients with uncomplicated active rheumatoid arthritis is equivalent and that there is no difference in the use of resources. The study demonstrated that the day-patient and inpatient care are clinically equivalent for patients with active rheumatoid arthritis. The overall resource costs of day-patient care are slightly lower than those of inpatient care. Day care is associated with lower hospital costs but higher transport costs. Clinical benefit from either form of management is short lived. The background to this work and the implications of the results are discussed.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:653640 |
| Date | January 1999 |
| Creators | Lambert, C. Michael |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/26673 |
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