2.6 Case studies

This section presents several cases whereby alternative models of care resulted in improvement to patient care and cost savings.

Collecting and analysing the right measures allows for a holistic assessment of which model of care is best suited to meet defined objectives, address stakeholder needs and deliver high-quality, cost-effective healthcare.

Case 1: MeCare

A study by Carter at al. (2023) explored the impact of a new telehealth program (MeCare) on healthcare resource use, costs and patient-reported outcomes. The intervention involves a funded program from a health service to enable patients to self-manage their chronic diseases (Carter et al., 2023). It consists of a virtual care platform that uses home-based remote monitoring of patients’ clinical measurements of blood pressure, heart rate and oxygen levels as outcome measures to identify patient progress.

The study used a pre and post design whereby baseline and post-intervention data were collected using administrative databases. Nursing staff did initial assessments to ensure the suitability of the patients to be part of the program. Real-time feedback and patient management was done remotely by trained nurses with access to the platform at the health service (Carter et al., 2023).

The program is provided free of charge to patients in the health service. However, the health service pays a fee per participant to the company providing the electronic platform for the provision of home equipment for patients for the ongoing monitoring (Carter et al., 2023).

Baseline data showed that patients enrolled in the study had a relatively high health services utilisation, amounting to A$34,000 per participant in the 12 months prior to enrolment. After implementation of the intervention and taking into account the cost of the program, there was a net saving of A$982 per participant-month for the health service, totalling to about A$2.3 million annually for this cohort. Participants also reported a high level of satisfaction with the program monthly.

The results of this study reinforce the benefits of using an alternative model of care such as telehealth for managing chronic disease (WHO, 2018). It was hypothesised that the savings were mainly from the adoption of multidisciplinary team care coordination, where nursing staff were more focused on ensuring patients were proactive in the management of their health, and the tailored model focused on prevention, which resulted in less access to health services or GP visits.

While the benefit of such programs is evident for health services and participants, maintaining such a program depends on ongoing funding from the health service as well as the full engagement of enrolled participants over the required time of their management. Patient attrition might render the program less effective in the long run. Further work is needed to explore how participant engagement can be improved to get the full benefit of these programs.

Case 2: Pharmacists in an intensive care unit

A study by Muñoz-Pichuante and Villa-Zapata (2020) detailed the impact of incorporating a pharmacist in an intensive care unit (ICU) working with a multidisciplinary team to advise on medication-adverse events, doses changes and overall management (Muñoz‐Pichuante & Villa‐Zapata, 2020). The study showed that across 12 months, pharmacists made 505 interventions for 169 patients. The interventions were grouped into six categories:

• prevention of adverse events
• resource utilisation
• individualisation of patient care
• prophylaxis management recommendation
• hands-on care, which includes a variety of interventions such as patient education
• support during crisis management.

Ninety per cent of these interventions were taken up by the medical team, which is aligned with other studies (Dalton & Byrne, 2017; Khalil, 2011). The savings from this model of care were calculated as cost savings and cost–benefit ratio. The authors concluded that incorporating a clinical pharmacist in a collaborative ICU team reduced healthcare expenses through treatment adjustment converted into cost avoidance. The total cost savings over the 12 months of the study were $US263,500, resulting in a cost–benefit ratio of 1:24.2.