Opinions of general and adult congenital heart disease cardiologists on care for adults with congenital heart disease in Belgium: a qualitative study

Abstract

Background:The growing adult congenital heart disease (CHD) population requires efficient healthcare organisation. It has been suggested that clinically appropriate care be provided for individual patients on the least complex level possible, in order to alleviate saturation of special care programmes.Methods:Semi-structured interviews with 10 general and 10 adult CHD cardiologists were conducted to elucidate opinions on healthcare organisation in Belgium. A particular focus was placed on the potential role of general cardiologists. The software program NVivo 12 facilitated thematic analysis.Results:A discrepancy existed between how general cardiologists thought about congenital care and what adult CHD cardiologists considered the minimum knowledge required to adequately treat patients. Qualitative data were categorised under the following themes: knowledge dissemination, certification, (de)centralisation of care, the role of adult CHD cardiologists, the role of dedicated nurse specialists, and patient referral. It appeared to be pivotal to organise care in such a way that providing basic care locally does not impede the generation of sufficient patient volume, and to continue improving communications between different care levels when there is no referral back. Moreover, practical knowledge is best disseminated locally. Cardiologists’ opinions on certification and on the role of dedicated nurse specialists were mixed.Conclusion:On the basis of the results, we propose five recommendations for improving the provision of care to adults with CHD. A multidimensional approach to defining the role of different healthcare professionals, to improving communication channels, and to effectively sensitising healthcare professionals is needed to improve the organisation of care.

Outpatient care of adults with congenital heart disease in the UK: a qualitative appraisal of the clinician perspective

“…This dynamic is also observed in other countries and poorer outcomes are observed when non-specialists manage patients with ACHD. 15 16 …”

Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

“…Our study showed that both patients with mild and moderate lesions under highly specialized cardiac care incurred less hospitalization, outpatient and pharmaceutical costs in the medium term compared to patients under general cardiac care. It is therefore important to keep working on referral patterns from general to specialized cardiac care by improving communication, feedback, and knowledge distribution between care levels [19].…”

Changes of hospitalization trend in the pediatric cardiology division of a single center by increasing adult with congenital heart disease

“…The growing population of adults with CHD requires efficient healthcare organizations. We need a multidimensional approach to defining the role of different healthcare professionals, improvement of communication channels, and certification or training programs for healthcare professionals including physicians, surgeons, and nurses [2,12]. A follow-up program or guidelines for specific CHDs might be useful and help physicians with the long-term management of patients and early detection of various complications [2].…”

“…When adult patients with CHD undergo ICU care, knowledge of CHD might be critical, and the need for pediatric cardiologic intensivists is increasing. Because pediatric cardiologic intensivists usually have experience in post-operative periods, heart failure, mechanical cardiac support, and post-heart transplantation management, they can decide the optimal timing for mechanical cardiac support and heart transplantation [12].…”