Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams?

Abstract

BackgroundAn ageing population and high levels of multimorbidity increase rates of GP and specialist consultations. Constraints on health care funding are leading to additional pressure for the adoption of safe and cost-effective alternatives to specialist care, in some cases by shifting services to primary care.DiscussionIn this paper we argue, having searched for evidence on approaches to shifting care for some people with cardiovascular problems from secondary to primary care, that a collaborative, multidisciplinary approach is required to achieve high quality outcomes from cardiovascular care in the primary care setting. Simply transferring patients from specialist care to management by primary care teams is likely to lead to worse outcomes than services that involve both specialists and primary care teams together, in planned and effectively managed systems of care.The care of patients with certain chronic conditions in the community, if appropriately organised, can achieve the same health outcomes as ambulatory care by hospital specialists. However, shared care by GPs and specialists for patients with chronic heart failure after discharge from hospital can deliver better patient survival. The existing models of shared care include specialists working in an ambulatory care setting (in Central and Eastern Europe) or in hospital based outreach clinics, and cardiology care organised by GPs in the UK and Australia, which have demonstrated reductions in referral rates.SummaryCurrent research supports the idea of the management of certain chronic health conditions in primary care based on the integration of GPs and specialists into multidisciplinary teams, based on availability of reliable evidence about cost-effectiveness, health care outcomes, patient preference and incentives for GPs. Evaluation of such schemes is mandatory, however, to ensure that the expected benefits do materialise.

Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review

“…National guidelines and regulatory, financial and incentive schemes provide a starting point for organisations to develop services according to their local specifications. Without explicit and detailed programmes ready to be implemented, many organisations across the country have been testing new and innovative solutions; about 50 NHS vanguards, 25…”

“…There are a variety of reasons for such failure of integrated care. disease, 22,23 musculoskeletal condition, 24 cardiovascular disorder, 25 and glaucoma. 26 The particular issues in healthcare management across long-term conditions included problems of working together between primary and secondary care related to poor relationships and different perceptions of priorities or standards, 27,28 and the role of integrated health records in integration of care.…”

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