Reduced utilization and cost of primary care clinic visits resulting from self-care education for patients with osteoarthritis of the knee

Objective, To determine the extent to which the cost of an effective self-c are intervention for primary care patients with knee osteoarthritis (OA) wa s offset by savings resulting from reduced utilization of ambulatory medica l services. Methods. In an attention-controlled clinical trial, 211 patients with knee OA from the general medicine clinic of a municipal hospital were assigned a rbitrarily to conditions of self-care education (group E) or attention cont rol (group AC), Group E (n = 105) received individualized instruction and f ollowup emphasizing nonpharmacologic management of joint pain. Group AC (n = 106) received a standard public education presentation and attention-cont rolling followup, A comprehensive clinical database provided data concernin g utilization and cost of health services during the following year. Results, Only 25 subjects (12%) were lost to followup, The 94 subjects rema ining in group E made 528 primary care visits during the year following int ervention, compared with 616 visits by the 92 patients remaining in group A C (median visits 5 versus 6, respectively; P < 0.05), Fewer visits translat ed directly into reduced clinic costs in group E, relative to controls (med ian costs [1996 dollars] $229 versus $305, respectively; P < 0.05), However , self-care education had no significant effects on utilization and costs o f outpatient pharmacy, laboratory, or radiology services over the ensuing y ear. The cost per patient to deliver the self-care intervention was estimat ed to be $58.70, Conclusion. Eighty percent of the cost of delivering effective self-care ed ucation to the knee OA patients in this study was offset within 1 year by t he reduced frequency and costs of primary care visits, For >50% of patients receiving the intervention, the savings associated with fewer primary care visits exceeded the cost of self-care education.