Continuity of care in the approach to cardiac patients: from theory to practice/Continuidad asistencial en el abordaje del paciente cardiaco: de la teoría a la práctica

The Department of Cardiology of our hospital has a catchment population of 135,000 people. Until 2005, the relationship between the various levels of care (primary care, and secondary and tertiary hospitals) was incidental. Patients were seen at different levels of care and complementary tests were duplicated due to the lack of connections between these levels, with all the implications this has for patients, quite apart from the associated costs for the health service.


Introduction
The Department of Cardiology of our hospital has a catchment population of 135,000 people. Until 2005, the relationship between the various levels of care (primary care, and secondary and tertiary hospitals) was incidental. Patients were seen at different levels of care and complementary tests were duplicated due to the lack of connections between these levels, with all the implications this has for patients, quite apart from the associated costs for the health service.
In 2005, the CSI HGH took charge of cardiology care in the catchment area, integrating the outpatient cardiology care of five primary care (PC) health districts (Florida Norte, Florida Sur, Pubilla Cases, Collblanc and Torrasa). In the first year, 12,000 appointments were carried out. The first intervention put into place was to transfer the care of all the monitored patients with no identified heart disease or with only minor conditions to PC. With this step, we managed to reduce the number of visits to specialists of the Department of Cardiology by 30% in two years. Another intervention was introduced in 2007: the establishment of clinical sessions bringing together professionals of the Department of Cardiology and PC. A cardiologist was appointed for referral of non-complex chronic heart patients and for advising primary care colleagues. Despite all this, the response was not consistent across PC, so we proposed to segment the cardiology care offer, according to the needs of our internal client, that is, primary care.

Description of the intervention
The objective was to redefine cardiac care processes towards patient-based care through a model of care that provides specialised care tailored to the needs of the 'client' within the care system as well as of patients. patients ranging from 43 to 90 years of age have been assessed (Table 1).
Of the patients examined, HF was confirmed in 36 cases and the underlying causes are detailed in Figure 1.
3. Outcomes of the high-resolution CIU from June to July 2011: A total of 20 patients were assessed. Patient age ranged from 25 to 88 years old, with 9 patients being octogenarians. The reasons for the referral are listed in Table 2.
The outcomes with respect to the achievement of diagnosis for the processes that had been the reason for the consultation are reported in Figure 2.
4. Outcomes of the virtual consultations: Over a period of three months, 34 consultations were carried out and, of these, 32 have were resolved virtually. It was only considered necessary for two patients to attend appointments in person to be assessed (in the high-resolution CIU or at a conventional specialist appointment).

Discussion
Until 2005, the relationship between levels of care was incidental. Despite the fact that there were significant initiatives between primary and specialised care, well received by the latter, a direct connection had not developed between levels of care. Since the time cardiology care came under the responsibility of our hospital, a series of interventions have been put in place in order to agree with primary care, as well as within   tertiary care, pathways and criteria for action in line with clinical practice guidelines to provide continuity of care to patients regardless of the level of care where they are treated.

Conclusions
Consensus among the various different levels of care involved in the process, from a client-provider (PC-Hospital) perspective, is essential to determine, on the basis of care needs and the principle of subsidiarity, who does what and where.
With the establishment of new practices in integrated patient care, we aim to respond to the care processes that are the reason for consultations quickly and efficiently.
Our vision is to develop a cardiology unit capable of adapting its responses to care process requirements as requested by its internal client.
Con la puesta en marcha de las nuevas medidas en la atención integral del paciente, se espera dar respuesta al proceso que motiva la consulta en la mayor parte de los casos de forma breve y eficaz. Nuestra visión es disponer de un servicio de cardiología capaz de adecuar sus respuestas asistenciales a la necesidad asistencial del proceso solicitado desde el nivel asistencial cliente.