An economic evaluation of the Virtual Rural Generalist Service versus usual care in Western NSW Local Health District

Abstract

Objective

Evaluate the cost-effectiveness of the Virtual Rural Generalist Service (VRGS) model of care.

Design

A cost–consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non-VRGS] doctors) from the perspective of the health care funder in 2022 prices.

Setting

Twenty-nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites).

Patients

Patients of any age who presented to an emergency department (ED) or were admitted to hospital at VRGS sites over the pre-VRGS period (1 February 2019 to 31 January 2020) or the post-VRGS period (1 July 2021 to 30 June 2022).

Intervention

The VRGS model of care, which provides 24-hour 7-days-a-week rural generalist doctors, both virtually and in person, to small rural and remote hospitals, predominantly for lower acuity ED presentations, daily ward rounds for inpatients admitted by a VRGS medical officer, and ad hoc inpatient medical reviews when local doctors need support or are unavailable.

Main outcomes measures

Incremental cost per incremental quality-of-care outcome, maintenance of health service activity levels, workforce sustainability (measured by changes in locum shifts), and service acceptability (as determined by thematic analysis of interviews).

Results

The cost per standard unit of health care (national weighted activity unit) was lower for the VRGS ($1047) than for usual care ($1753). VRGS doctors dealt with ED presentations of similar complexity to non-VRGS doctors, and admissions of significantly lower (40%) complexity. Health service activity remained stable from the pre-VRGS period to the post-VRGS period, only declining by 4% in the post-VRGS period, which was during the coronavirus disease 2019 pandemic. Locum shifts decreased from 1456 days in the pre-VRGS period to 609 days in the post-VRGS period, improving the sustainability of the workforce. Local doctors and managers found the VRGS to be acceptable, but thought it could be enhanced with additional investment in nursing and technical staff.

Conclusions

Our economic evaluation of the VRGS showed that it provided lower cost care and equivalent quality-of-care outcomes when compared with usual care for ED presentations of the same complexity, and supported local clinical staff to maintain activity levels despite a pandemic. With additional investment in data capture and in nursing and technical staff to support the service, the VRGS has promise as a flexible service that can help sustain access to quality medical care in rural and remote communities.