OBJECTIVES

: Patients with stomas (ostomates) are at high risk of peri-stomal skin complications (PSC), leading to patient distress and financial burden. This study investigated if a community specialist nurse-led review and intervention programme conferred cost savings.

METHODS

: Ostomates from 179 primary care practices were invited to attend a review from stoma care specialist nurses, where the; prevalence of complications and whether the patient would have sought help elsewhere, were recorded. Interventions carried out included; advice, stoma product changes and ceasing inappropriate products. A cost analysis model was used to; quantify the annual cost of treating PSC using £204.77/7weeks x 7.4 episodes, and to quantify decreased resource usage. To calculate cost savings from avoided visits, unit costs per appointment were; £127 stoma care nurse (SCN), £37 General Practitioner (GP) and £202 Emergency Department (ED). Savings from changed product usage were based on individual product costs.

RESULTS

: Initial visits were conducted with 1968 ostomates, median age of 72 years (62-80 IQR). Demographics were; males 54% (n=1,065), cancer 40% (n=792) and stoma duration greater than 5 years 47% (n=920). PSC was reported by 24% (n=469). The annual mean cost per patient of treating PSC was £1515.27 and for the sample was £715,690.50. The mean annual cost savings from avoided appointments were; £53,523 (SCN), £6,618 (GP) and £346 (ED). A 10% decrease in product costs was seen, corresponding to £450,106 as an annual cost saving in the study group.

CONCLUSIONS

: A nurse led review programme identified previously unrecognised stoma issues reported by ostomates, including among those with long term stomas. Nurse led intervention conferred cost benefits not only from decreasing product costs but by diverting ostomates from alternative NHS resources.