Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Driscoll, Andrea, Worrall-Carter, Linda, Hare, David, Davidson, Patricia, Riegel, Barbara, Tonkin, Andrew and Stewart, S. 2007, Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs, in ESC 2007 : European Heart Journal : Abstract Supplement, Oxford University Press, United Kingdom, pp. 83-83.

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Title Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs
Author(s) Driscoll, AndreaORCID iD for Driscoll, Andrea orcid.org/0000-0002-6837-0249
Worrall-Carter, Linda
Hare, David
Davidson, Patricia
Riegel, Barbara
Tonkin, Andrew
Stewart, S.
Conference name European Society of Cardiology. Congress (2007 : Vienna, Austria)
Conference location Vienna, Austria
Conference dates 1-5 September 2007
Title of proceedings ESC 2007 : European Heart Journal : Abstract Supplement
Publication date 2007
Start page 83
End page 83
Publisher Oxford University Press
Place of publication United Kingdom
Summary Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.
Language eng
Field of Research 110201 Cardiology (incl Cardiovascular Diseases)
HERDC Research category E3 Extract of paper
Persistent URL http://hdl.handle.net/10536/DRO/DU:30014932

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