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Conference Abstracts

Co-speciality cross-boundary supportive care: a highly integrated approach addressing the palliative care needs of advanced heart failure patients

Author:

Clea Atkinson

Cardiff & Vale University Health Board Cardiff University School of Medicine, GB
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Abstract

Introduction: Heart failure (HF) is an increasingly prevalent condition associated with poor quality-of-life and high symptom burden, yet there is significant inequity of access for non-cancer patient to palliative care services despite increasing evidence of benefit. HF patients experience an unpredictable disease trajectory and repeated acute admissions towards the latter stages of life, with most dying in hospital despite a preference to remain home. As patients reach ceilings of survival-extending interventions, personalised patient-identified priorities may be more readily addressed through the support of palliative care services. However, there are many barriers to referral and the best model of care remains unestablished

Objectives/Aims/Methods: In 2016 the Heart Failure Supportive Care Service (HFSCS) was established to provide holistic support to advanced HF patients in the last years of life. The aim was to create and evaluate a co-speciality cross-boundary service model that better provides for their palliative care needs, whilst delivering a more patient-centred and cost-effective patient journey. Patient experience was evaluated through questionnaires developed and distributed in mid-2018 and end-of-2020. Referrer feedback was surveyed digitally. Actual and indexed hospital admission data (in-patient bed days pre-/post-referral) were used allowing statistical comparisons by paired student t-tests. Cost mapping analysis allowed approximation of cost-saving benefits.

Results: From 2016-2020, 236 patients were referred to the HFSCS and were seen in joint co-speciality clinics, with ongoing management regularly reviewed at co-speciality MDTs and hospital to community outreach being provided. Overall, 75/118 patient experience questionnaires were returned. Patients felt the HFSCS delivered compassionate and co-ordinated care (84% and 80%) that improved their symptoms and quality of life (80% and 65%). Introduction of the HFSCS resulted in a statistically significant reduction in HF-related admissions: actual days 18.3 to 4 days (p<0.001), indexed days 0.05 to 0.032 days (p=0.03), and a 50% reduction in hospital deaths over 5 years. Cost mapping revealed an estimated average saving of at least £10,218.36 per referral and a total estimated cost saving of approximately £2.4 million over 5 years. Cardiology specialists rated this service highly (9/10) and especially recognised the benefits of an overlapping co-speciality approach with greater integration of care (100%). 

Conclusions: This service design demonstrates that co-speciality cross-boundary care delivery can successfully provide the benefits of palliative care to HF patients in a cost-effective manner, whilst meeting patient-identified priorities of care. The extent of overlapping co-speciality integration is likely to underpin the observed value-based outcomes and addresses many barriers to referral.

Applicability/transferability/sustainability/limitations: Increased scalability of this model is offered by the better acceptability to referrers, benefits of integrated working and simplicity in reconfiguration of already available professional skills. This approach is now being successfully piloted for HF in a number of other Health-boards in Wales plus other life-limiting non-cancer conditions in CVUHB.

How to Cite: Atkinson C. Co-speciality cross-boundary supportive care: a highly integrated approach addressing the palliative care needs of advanced heart failure patients. International Journal of Integrated Care. 2022;22(S3):486. DOI: http://doi.org/10.5334/ijic.ICIC22255
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Published on 04 Nov 2022.

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