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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Harindra C Wijeysundera, Gina Trubiani, Lusine Abrahamyan, Nicholas Mitsakakis, William Witteman, Mike Paulden, Gabrielle van der Velde, Kori Kingsbury, Murray Krahn
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-236) contains supplementary material, which is available to authorized users.

Competing interests

None of the authors have any conflicts of interest to declare.

Authors’ contributions

HCW Conception, design, acquisition, analysis and interpretation of data; drafting of manuscript; final approval of manuscript submitted. GT Design, acquisition and analysis of data; drafting of manuscript; final approval of manuscript submitted. LA Acquisition and analysis of data; revising of manuscript; final approval of manuscript submitted. NM Conception, design, analysis and interpretation of data; drafting of manuscript; final approval of manuscript submitted. WW Acquisition of data; revising of manuscript; final approval of manuscript submitted. MP Analysis, and interpretation of data; revising of manuscript; final approval of manuscript submitted. GvV Conception and design; revising of manuscript; final approval of manuscript submitted. KK Conception and design; revising of manuscript; final approval of manuscript submitted. MK Conception, design, analysis and interpretation of data; revising of manuscript; final approval of manuscript submitted. All authors read and approved the final manuscript.

Abstract

Background

Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province.

Methods

As part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics.

Results

We identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care.

Conclusions

Multiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.
Zusatzmaterial
Additional file 1: Appendix A. Heart Failure Clinic Stratification using Concept Mapping. (DOC 35 KB)
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Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
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Literatur
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