effectiveness and cost-effectiveness of primary therapist model for the management of patients with rheumatoid arthritis.
Published: 2004
Language: eng
Number of pages: 196
Description: Objective. To evaluate the effectiveness and cost-effectiveness of the primary therapist model (PTM), an alternative service delivery model involving the use of multi-skilled, rheumatology trained rehabilitation therapists, for managing patients with rheumatoid arthritis (RA).Methods. The evaluation consisted of four parts. First, a systematic review was performed to examine the evidence on comprehensive physical therapy and occupational therapy for managing RA. Second, a pilot study was performed to compare the PTM with standard medical care. Third, a pragmatic RCT was conducted to compare the outcome of patients who were referred for treatment provided by a primary therapist and of those who were referred to the traditional therapy model. The primary outcome was the percentage of patients with a positive clinical response at six months, defined as a &ge;20% improvement in at least two of three measures (Health Assessment Questionnaire (HAQ) disability index, HAQ pain index, and ACREU RA Knowledge Questionnaire). Fourth, a cost-effectiveness analysis was conducted within the context of the RCT to examine the economic benefits of PTM, compared to traditional therapy (TT), from the perspectives of society (base case) and the health care system. Sensitivity analyses were performed over various approaches for costing lost productivity.Results. Of the 144 consenting patients, 73 were assigned to the PTM group and 71 to the TT group. A total of 111 patients (PTM = 63; TT = 48) completed the required assessments and were included in the analysis. At six months, 44.4% of patients in the PTM group met the clinical response criterion versus 18.8% in the TT group (chi2 = 8.09, df = 1, p = 0.004). The base-case economic evaluation showed that the use of PTM resulted in a cost-utility of $13,675 per QALY gained compared to the TT. From the perspective of Ministry of Health, the PTM dominated the TT, with an overall annual cost saving of $1,060 per patient.Conclusion. Patients who were referred to receive treatment for RA from a primary therapist might achieve better outcomes than those who were referred to traditional therapy. The results, however, should be interpreted with caution due to the high rate of dropout in the TT group.
Notes: Adviser:  Claire Bombardier.

Thesis (Ph.D.)--University of Toronto, 2004.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 65-05, Section: B, page: 2381.