Background
Methods
Identification of Heart Failure Clinics
Clinic name and location | |
---|---|
1. | Cornwall: Cornwall Community Hospital |
2. | Hamilton: Heart Function Clinic - Hamilton Health Sciences Corporation |
3. | Kingston: Hotel Dieu Hospital |
4. | Kitchener: St. Mary's Hospital |
5. | London: London Health Sciences Centre |
6. | Oakville: Oakville-Trafalgar Memorial Hospital |
7. | Orillia: Orillia Soldiers' Memorial Hospital |
8. | Ottawa: University of Ottawa Heart Institute |
9. | Owen Sound: Grey Bruce Health Services |
10. | Picton: Prince Edward Family Health Team Heart Failure Clinic |
11. | Toronto: University Health Network (UHN) (1) |
12. | Toronto: University Health Network (UHN) (2) |
13. | Toronto: Mt Sinai Heart Function Clinic |
14. | Toronto: St Michael’s Hospital Heart Function Clinic |
15. | Toronto: Sunnybrook Hospital Heart Function Clinic |
Regional differences in access to HF Clinics
Semi-structured Interview
Intervention category | Points to be assigned |
---|---|
Recipient
| 1 = Provider alone |
2 = Patient alone | |
3 = Patient with some inclusion of caregiver | |
4 = Patient with a caregiver who is central to the intervention | |
Intervention content
| |
Education and counselling aimed at supporting self-care
| 0 = No mention of education |
1 = Focus solely on importance of treatment adherence | |
2 = Focus on treatment adherence including some creative methods of improving adherence | |
3 = Focus on surveillance but no mention of actions to be taken in response to symptoms (eg, no flexible diuretic management) | |
4 = Emphasis on surveillance, management, and evaluation of symptoms in addition to treatment adherence | |
Medication management
| 0 = No mention of medication regimen |
1 = Some mention of medications (eg, importance of medication compliance) but not an active part of the intervention. No attempt to intervene with provider to get patients on an evidence-based medication regimen | |
2 = Evidence-based medication regimen advocated but no follow-up with patient or provider to monitor the suggestion | |
3 = Medication regimen monitored, attempt made to get the patient on evidence-based medications, with follow-up monitoring done with patient or provider | |
Social support Peer support
| 0 = No mention of a peer support intervention |
1 = Peer support mentioned but not integral to intervention | |
2 = Peer support integral component of intervention | |
Surveillance by provider:
Remote monitoring
| 0 = No use of remote monitoring or telehealth |
1 = Remote monitoring is used in conjunction with other interventions that form the main intervention used | |
2 = Telehealth is essential component of intervention | |
Delivery personnel
| 1 = Single generalist provider (eg, physician, nurse, pharmacist) |
2 = Single HF expert provider (eg, physician, nurse, pharmacist) | |
3 = Multidisciplinary intervention | |
Method of communication
| 1 = Mechanized via internet or telephone |
2 = Person-to-person by telephone | |
3 = Face-to-face, individual, or in a group | |
4 = Combined: Face-to-face at least once alone or in a group with individual telephone calls in between meetings | |
Intensity and complexity
| |
Duration
| 1 = ≤1 mo |
2 = ≤3 mo | |
3 = ≤6 mo | |
4= > 6 mo | |
Complexity
| 1 = Low: single contact with little or no follow-up |
2 = Moderate: >1 but <4 and/or infrequent contact or contacts of short duration | |
3 = High: multiple contacts of significant duration | |
Environment
| 1 = Hospital: Inpatient only |
2 = Clinic/outpatient setting | |
3 = Home-based | |
4 = Combination of settings |
Institutional review board
Results
HF clinic identification
Regional distribution of HF clinics
LHIN | # HF Clinics | Total Population | population per HF Clinic | age 65 years and over in LHIN | >65 years population per HF clinic | annual HF discharge per HF clinic |
---|---|---|---|---|---|---|
Erie St. Clair | 0 | 623,300 | NA | 85,000 | NA | NA |
South West | 3 | 890,100 | 296,700 | 125,800 | 41,900 | 247 |
HNHB | 2 | 1,298,300 | 649,100 | 192,400 | 96,200 | 591 |
Waterloo Wellington | 5 | 679,700 | 135,900 | 76,000 | 15,200 | 84 |
Mississauga Halton | 3 | 1,002,300 | 334,100 | 103,400 | 34,500 | 155 |
Central West | 0 | 735,200 | NA | 65,900 | NA | NA |
Central | 2 | 1,522,800 | 761,400 | 183,100 | 91,600 | 395 |
Central East | 3 | 1,419,800 | 473,300 | 184,600 | 61,500 | 305 |
Toronto Central | 6 | 1,075,100 | 179,200 | 131,800 | 22,000 | 118 |
North Simcoe Muskoka | 3 | 417,000 | 139,000 | 59,900 | 20,000 | 108 |
South East | 2 | 457,200 | 228,600 | 74,700 | 37,400 | 217 |
Champlain | 3 | 1,131,400 | 377,100 | 137,600 | 45,900 | 247 |
North East | 1 | 545,000 | 545,000 | 84,900 | 84,900 | 626 |
North West | 1 | 231,900 | 231,900 | 31,400 | 31,400 | 218 |
Total | 34 | 12,028,900 | 353,800 | 1,536,500 | 45,200 | 200 |
Clinic characteristics
Access to allied health professionals
Parameter | |
---|---|
PERSONEL
| |
Mean number of Physicians | 4.7 (1–8)* |
% of clinics with cardiologist | 80.6 |
% of clinics with internists | 22.6 |
% of clinics with family physicians | 9.7 |
% of physicians with heart failure training | 80.6 |
Mean Number of Nurses | 2.0 (1–6)* |
LOCATION
| |
% Academic | 25.8 |
% Community Based | 74.2 |
Mean Annual Total Visits | 1020 (200–1479)* |
Mean Annual Total New Patients | 139 (25–128)* |
% Access to Onsite Echocardiography | 80.6 |
% Access to Onsite Nuclear Cardiology Testing | 58.1 |
% Access to Onsite Angiography | 38.7 |
% Access to Onsite exercise Stress Testing | 77.4 |
Mean Exam Rooms | 3.3 (1–4)* |
ALLIED HEALTH PROFESSIONALS
| |
% Access to Dietician (In Clinic) | 45.2 |
% Access to Pharmacist (In Clinic) | 32.3 |
% Access to Physiotherapy (In Clinic) | 6.5 |
% Access to Counselor (In Clinic) | 16.1 |
% Affiliated with Cardiac Rehabilitation | 87.1 |
% Involved in other Chronic Disease Management | 64.5 |
Intensity and complexity
Concept mapping
HF-DMSI category | All clinics (n = 30) | Clinic intensity types | |||
---|---|---|---|---|---|
High | Medium | Low | p-value | ||
(n = 10) | (n = 13) | (n = 7) | |||
Recipient | 3.3 ± 0.6 | 3.7 ± 0.5 | 3.2 ± 0.6 | 3.0 ± 0.6 | .040 |
Education and counselling aimed at supporting self-care | 3.2 ± 1.0 | 3.9 ± 0.3 | 3.1 ± 1.0 | 2.6 ± 1.1 | .011 |
Medication management | 2.7 ± 0.5 | 3.0 ± 0 | 2.8 ± 0.4 | 2.1 ± 0.7 | .002 |
Peer support | 0.3 ± 0.5 | 0.6 ± 0.7 | 0.2 ± 0.4 | 0.3 ± 0.5 | .147 |
Remote monitoring | 0.7 ± 0.8 | 1.0 ± 0.8 | 0.8 ± 0.8 | 0.1 ± 0.4 | .079 |
Delivery personnel | 2.5 ± 0.6 | 3.0 ± 0 | 2.5 ± 0.5 | 2.0 ± 0.8 | .002 |
Method of communication | 3.6 ± 0.5 | 4.0 ± 0 | 3.5 ± 0.5 | 3.4 ± 0.5 | .018 |
Duration | 4.0 ± 0 | 4.0 ± 0 | 4.0 ± 0 | 4.0 ± 0 | - |
Complexity | 2.6 ± 0.6 | 3.0 ± 0 | 2.6 ± 0.5 | 2.0 ± 0.6 | <.001 |
Environment | 2.0 ± 0.2 | 2.0 ± 0 | 1.9 ± 0.3 | 2.0 ± 0 | .536 |