Authors:

Abstract

Introduction: Current international data suggests 2% prevalence of symptomatic Heart Failure in Ireland, with over 10,000 cases diagnosed annually. Limited access to timely diagnostics and specialist opinion impede effective community care of this complex disease.  Structured care and appropriate early intervention in the community and outpatient setting has been shown to reduce emergency hospitalisations.

The project provided a Heart Failure Virtual Consultation (HF VC) Service, with community based integrated care clinical nurse specialist (IC CNS) support, building on an earlier pilot.

Key to VC is development of integrated care and communication between primary and secondary care with prompt access to specialist opinion and community diagnostics.

Aim, Objectives, Theory or Methods: Project aim: provide an efficient service for HF patients presenting to GPs, reduce unnecessary  referrals to routine hospital based outpatient service and improve treatment in the community through IC CNS-GP aided care.

Method: GP’s refer patient cases to a virtual online Specialist Consultant clinic. Multiple GP’s can join simultaneously. The referral data is anonymised. Each case is discussed online and consensus approach reached for the future management of each patient, including access to community diagnostics. IC CNS’s provide patient appointments and enables GP’s to safely manage an at-risk population in the community. The service is implemented by a Cardiologist led hub team, with GP advice.

Highlights or Results or Key Findings: Results:

Immediate Benefit:

•91% of patients would have been referred to secondary care if VC service was not available.  As a result of the service, only 12% were referred to secondary services (note: does not include investigations such as echo).

GP feedback:

•83% said gaining enhanced knowledge about management and treatment of heart failure patients was of ‘major benefit’ and 17% stated it was of ‘moderate benefit’.

•100% said having access to expertise in heart failure management was of ‘major benefit’

•75% said achieving competence in caring for heart failure patients was of ‘major benefit’, while 25% said it was of ‘moderate benefit’

Patient feedback:

•120,000 kms in travel miles was avoided for patients and their families

•Patient testimonials included: ‘Excellent service. All I needed was a change of medication and did not have to go to hospital’; ‘I was medically managed within my community. No long waiting lists or travel’.

Conclusion: The Heart Failure Virtual Consultation service with community integrated care clinical nurse specialist supports provides:

•Culture change in how GPs “consult” with hospitals

•Culture change in how patients use hospitals

•Culture change in how we work together

This is integrated care – right care, right place, right time.

Implications for applicability/transferability, sustainability, and limitations

The VC is a novel/scalable integrated-care pathway between primary and secondary care. The data travels, not the patient. GP access to timely consultant advice, appropriate diagnostics and community CNS’s allows optimum care (and self-care) for patients. Best-practice integrated care is provided in the community, close to home and not in hospital.