The cost of changing physical activity behaviour: evidence from a "physical activity pathway" in the primary care setting

BMC Public Health

Research Article

Karen E Milton¹  Fiona C Bull²  Julia A Fox-Rushby³  Christian EH Boehler³ 

[1] British Heart Foundation National Centre for Physical Activity and Health, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, LE11 3TU, Loughborough, Leicestershire, UK;British Heart Foundation National Centre for Physical Activity and Health, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, LE11 3TU, Loughborough, Leicestershire, UK;School of Population Health, University of Western Australia, 35 Stirling Highway, 6009, Crawley, WA, Australia;Health Economics Research Group (HERG), Brunel University, UB8 3FG, Uxbridge, Middlesex, UK;

关键词: Physical Activity;    National Health Service;    Physical Activity Level;    Physical Activity Behaviour;    Care Pathway;   

DOI  :  10.1186/1471-2458-11-370

 received in 2010-09-15, accepted in 2011-05-23,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe 'Physical Activity Care Pathway' (a Pilot for the 'Let's Get Moving' policy) is a systematic approach to integrating physical activity promotion into the primary care setting. It combines several methods reported to support behavioural change, including brief interventions, motivational interviewing, goal setting, providing written resources, and follow-up support. This paper compares costs falling on the UK National Health Service (NHS) of implementing the care pathway using two different recruitment strategies and provides initial insights into the cost of changing physical activity behaviour.MethodsA combination of a time driven variant of activity based costing, audit data through EMIS and a survey of practice managers provided patient-level cost data for 411 screened individuals. Self reported physical activity data of 70 people completing the care pathway at three month was compared with baseline using a regression based 'difference in differences' approach. Deterministic and probabilistic sensitivity analyses in combination with hypothesis testing were used to judge how robust findings are to key assumptions and to assess the uncertainty around estimates of the cost of changing physical activity behaviour.ResultsIt cost £53 (SD 7.8) per patient completing the PACP in opportunistic centres and £191 (SD 39) at disease register sites. The completer rate was higher in disease register centres (27.3% vs. 16.2%) and the difference in differences in time spent on physical activity was 81.32 (SE 17.16) minutes/week in patients completing the PACP; so that the incremental cost of converting one sedentary adult to an 'active state' of 150 minutes of moderate intensity physical activity per week amounts to £ 886.50 in disease register practices, compared to opportunistic screening.ConclusionsDisease register screening is more costly than opportunistic patient recruitment. However, additional costs come with a higher completion rate and better outcomes in terms of behavioural change in patients completing the care pathway. Further research is needed to rigorously evaluate intervention efficiency and to assess the link between behavioural change and changes in quality adjusted life years (QALYs).

【 授权许可】

CC BY   
© Boehler et al; licensee BioMed Central Ltd. 2011