Treating the right patient at the right time: Access to heart failure care

Ross, Heather J.; Howlett, Jonathan G.; Arnold, J. Malcolm O.; Liu, P.; B, O'Neill; Brophy, James M.; Simpson, Cs S.; Sholdice, Mm M.; Knudtson, Merril L.; Ross, D.; Rottger, J.; Glasgow, Kevin

doi:10.1016/s0828-282x(06)70290-2

Cited by 85 publications

(52 citation statements)

References 31 publications

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“…To facilitate the referrals, the PCP should be familiar with the operation of the specialty clinic, including the roles of the physicians and RN/ANPs, as well as the usual clinic waiting time and benchmark waiting time (7), so that the referral request is appropriately planned and written. The referring physician should provide the specific reason for the referral and all relevant history and clinical tests, as well as insights into the patient's understanding and preferences.…”

Section: Transitional Carementioning

confidence: 99%

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

Arnold¹,

Howlett²,

Ducharme³

et al. 2008

Canadian Journal of Cardiology

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Section: Transitional Carementioning

confidence: 99%

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

Arnold¹,

Howlett²,

Ducharme³

et al. 2008

Canadian Journal of Cardiology

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“…[1][2][3][4] Amidst a growing call for the integration of palliative care into the care trajectory for patients with HF, [5][6][7][8][9][10][11][12] research methods are required to support the systematic exploration of the experiences of HF patients, family caregivers, and health care providers, as they interact as a care team. Such research is fundamental to support the development, implementation, and assessment of palliative care integration initiatives that are responsive and resilient to the team conditions in which HF care is negotiated.…”

Section: Introduction Problem Statementmentioning

confidence: 99%

Understanding Palliative Care on the Heart Failure Care Team: An Innovative Research Methodology

Lingard

McDougall

Schulz

et al. 2013

Journal of Pain and Symptom Management

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Context-There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team.Objectives-To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team.Methods-This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams.Results-We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps.Conclusion-We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease.

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“…That is why a patient-centric approach to wait times is essential, and why the Canadian Cardiovascular Society (CCS) has been insistent on the collection of more comprehensive wait time data (6). This is especially important for HF patients, who are among the sickest patients.…”

mentioning

confidence: 99%

“…This is especially important for HF patients, who are among the sickest patients. In 2006, the CCS was the first society to publish recommendations for standard wait times to assessment of HF by a specialist with expertise in that disorder (6,7). For instance, a standard referral for a patient with new-onset HF should be made and the patient seen within four weeks.…”

mentioning

confidence: 99%

I have heart failure – what happens now, Doc?

Howlett

2009

Canadian Journal of Cardiology

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It has been said one of the truest measures of a society is how its most vulnerable members are treated. I was reminded of this midway through last year. I received a call from a rural family physician regarding a very pragmatic 79-year-old patient, Mrs B, who he wished me to see. He explained to me that he had just seen her and thought she had severe new-onset heart failure (HF) after having followed her for several years with hypertension and atrial fibrillation. When she asked him why he wanted to refer her case, he explained to her that she had a very serious disease and she was at risk for worsening symptoms, hospitalization and death. At her insistence, he explained her life expectancy. When he told her that he was not certain when she would be seen, she asked, "If I have such little time, why can't I see someone soon for help?" He then called to enquire if I could see her urgently, which I did. It turned out she had occult mitral stenosis, and did well with intervention.As Canadians, we take great pride referring to our universal health care system. Despite this, significant ambivalence toward our health care system exists; grave concern is expressed about excessive wait times -even to the extent of citing the term 'medical tourism', where patients travel to other countries to receive procedures they cannot receive within the standard waiting period here. While significant efforts have been undertaken in Canada to shorten wait times for selected medical procedures, the same cannot be said for wait times for specialist referral. For example, most provinces report wait times for coronary artery bypass graft surgery. However, the wait time is calculated only after a patient has been placed on the waiting list for that surgery. From a patient perspective, this is only the latest in a long list of health system encounters, beginning with development of symptoms and continuing successively with a visit to the family doctor, referral to a specialist, and culminating with diagnostic testing (or even referral to another specialist). Each of these components is associated with its own separate wait list, but most of these are not recorded. Indeed, from a patient perspective, the reported wait time for coronary artery bypass graft surgery represents a small portion of the delay experienced by the patient.HF carries a very high risk: patients hospitalized with this condition suffer a one-year mortality in excess of 30%, and a life expectancy of approximately three years (1,2). With such an outcome expectation, surely individuals with HF can be considered vulnerable members of society who need medical assistance. Specialist involvement in the care of patients with HF improves the usage rate of treatments known to improve mortality rates (3). In addition, outcomes are improved when collaboration between primary and specialist caregivers occurs (4), although recent Canadian data indicated only a minority of patients with HF are followed by a specialist (5).That is why a patient-centric approach to wait times is essentia...

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Treating the right patient at the right time: Access to heart failure care

Cited by 85 publications

References 31 publications

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

Understanding Palliative Care on the Heart Failure Care Team: An Innovative Research Methodology

I have heart failure – what happens now, Doc?

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