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Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care
To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres. Observational, cross-sectional, analytical study. Patients from hospital em...
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| Published in: | Atención primaria 2016-04, Vol.48 (4), p.251-257 |
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| Main Authors: | , , , , , |
| Format: | Article |
| Language: | Spanish |
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| container_end_page | 257 |
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| container_title | Atención primaria |
| container_volume | 48 |
| creator | Fuentes Camps, Eva Luis del Val García, José Bellmunt Montoya, Sergi Hmimina Hmimina, Sara Gómez Jabalera, Efren Muñoz Pérez, Miguel Ángel |
| description | To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres.
Observational, cross-sectional, analytical study.
Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis.
A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years.
Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale.
DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P |
| doi_str_mv | 10.1016/j.aprim.2015.05.006 |
| format | article |
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Observational, cross-sectional, analytical study.
Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis.
A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years.
Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale.
DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited.
The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.</description><identifier>EISSN: 1578-1275</identifier><identifier>DOI: 10.1016/j.aprim.2015.05.006</identifier><identifier>PMID: 26298874</identifier><language>spa</language><publisher>Spain</publisher><subject>Aged ; Algorithms ; Cost-Benefit Analysis ; Cross-Sectional Studies ; Diagnosis, Differential ; Emergency Medical Services ; Female ; Humans ; Male ; Predictive Value of Tests ; Primary Health Care ; Venous Thrombosis - diagnosis ; Venous Thrombosis - economics</subject><ispartof>Atención primaria, 2016-04, Vol.48 (4), p.251-257</ispartof><rights>Copyright © 2015 Elsevier España, S.L.U. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26298874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fuentes Camps, Eva</creatorcontrib><creatorcontrib>Luis del Val García, José</creatorcontrib><creatorcontrib>Bellmunt Montoya, Sergi</creatorcontrib><creatorcontrib>Hmimina Hmimina, Sara</creatorcontrib><creatorcontrib>Gómez Jabalera, Efren</creatorcontrib><creatorcontrib>Muñoz Pérez, Miguel Ángel</creatorcontrib><title>Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care</title><title>Atención primaria</title><addtitle>Aten Primaria</addtitle><description>To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres.
Observational, cross-sectional, analytical study.
Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis.
A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years.
Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale.
DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited.
The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.</description><subject>Aged</subject><subject>Algorithms</subject><subject>Cost-Benefit Analysis</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis, Differential</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Primary Health Care</subject><subject>Venous Thrombosis - diagnosis</subject><subject>Venous Thrombosis - economics</subject><issn>1578-1275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNo1kFtLxDAQhYMg7rr6CwTJoy-tk6S5PUrxBgv6oM8lbSfapW1q0y747-3qCgNnhvmYcxhCrhikDJi63aVuGJsu5cBkCkuBOiFrJrVJGNdyRc5j3AFwboU-IyuuuDVGZ2vymoc4Jeg9VlOzxx5jpMHT6RNpjTjQPTb9Mo2hK0NsIq0b99H_dsMYqgO97A_WbvymlRvxgpx610a8POqGvD_cv-VPyfbl8Tm_2yYDy9iUuEpmBh0oD0Jyq0pnrABVM8NAVcorUaJy3GqfSWWk97WVJQgOAms0RokNufm7u-T4mjFORdfECtvW9RjmWDCtbca15mZBr4_oXHZYF8e4xf8XxA_M6l6S</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Fuentes Camps, Eva</creator><creator>Luis del Val García, José</creator><creator>Bellmunt Montoya, Sergi</creator><creator>Hmimina Hmimina, Sara</creator><creator>Gómez Jabalera, Efren</creator><creator>Muñoz Pérez, Miguel Ángel</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care</title><author>Fuentes Camps, Eva ; Luis del Val García, José ; Bellmunt Montoya, Sergi ; Hmimina Hmimina, Sara ; Gómez Jabalera, Efren ; Muñoz Pérez, Miguel Ángel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p141t-ac548ea06f035296ba89306d18106c6f63be6a297f45685ffd95b03203ede8863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>spa</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Algorithms</topic><topic>Cost-Benefit Analysis</topic><topic>Cross-Sectional Studies</topic><topic>Diagnosis, Differential</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Primary Health Care</topic><topic>Venous Thrombosis - diagnosis</topic><topic>Venous Thrombosis - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fuentes Camps, Eva</creatorcontrib><creatorcontrib>Luis del Val García, José</creatorcontrib><creatorcontrib>Bellmunt Montoya, Sergi</creatorcontrib><creatorcontrib>Hmimina Hmimina, Sara</creatorcontrib><creatorcontrib>Gómez Jabalera, Efren</creatorcontrib><creatorcontrib>Muñoz Pérez, Miguel Ángel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Atención primaria</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fuentes Camps, Eva</au><au>Luis del Val García, José</au><au>Bellmunt Montoya, Sergi</au><au>Hmimina Hmimina, Sara</au><au>Gómez Jabalera, Efren</au><au>Muñoz Pérez, Miguel Ángel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care</atitle><jtitle>Atención primaria</jtitle><addtitle>Aten Primaria</addtitle><date>2016-04</date><risdate>2016</risdate><volume>48</volume><issue>4</issue><spage>251</spage><epage>257</epage><pages>251-257</pages><eissn>1578-1275</eissn><abstract>To analyse the cost effectiveness of the application of diagnostic algorithms in patients with a first episode of suspected deep vein thrombosis (DVT) in Primary Care compared with systematic referral to specialised centres.
Observational, cross-sectional, analytical study.
Patients from hospital emergency rooms referred from Primary Care to complete clinical evaluation and diagnosis.
A total of 138 patients with symptoms of a first episode of DVT were recruited; 22 were excluded (no Primary Care report, symptoms for more than 30 days, anticoagulant treatment, and previous DVT). Of the 116 patients finally included, 61% women and the mean age was 71 years.
Variables from the Wells and Oudega clinical probability scales, D-dimer (portable and hospital), Doppler ultrasound, and direct costs generated by the three algorithms analysed: all patients were referred systematically, referral according to Wells and Oudega scale.
DVT was confirmed in 18.9%. The two clinical probability scales showed a sensitivity of 100% (95% CI: 85.1 to 100) and a specificity of about 40%. With the application of the scales, one third of all referrals to hospital emergency rooms could have been avoided (P<.001). The diagnostic cost could have been reduced by € 8,620 according to Oudega and € 9,741 according to Wells, per 100 patients visited.
The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.</abstract><cop>Spain</cop><pmid>26298874</pmid><doi>10.1016/j.aprim.2015.05.006</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | EISSN: 1578-1275 |
| ispartof | Atención primaria, 2016-04, Vol.48 (4), p.251-257 |
| issn | 1578-1275 |
| language | spa |
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| subjects | Aged Algorithms Cost-Benefit Analysis Cross-Sectional Studies Diagnosis, Differential Emergency Medical Services Female Humans Male Predictive Value of Tests Primary Health Care Venous Thrombosis - diagnosis Venous Thrombosis - economics |
| title | Cost-effectiveness of the deep vein thrombosis diagnosis process in primary care |
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