Gomez-Soto Francisco M, Puerto José L, Andrey José L, Fernandez Francisco J, Escobar Miguel A, Garcia-Egido Antonio A, Romero Sotero P, Bernal José A, Gomez F
Department of Internal Medicine, University Hospital Puerto Real, University of Cádiz School of Medicine, Cadiz, Spain.
Eur J Intern Med. 2008 Nov;19(7):548-54. doi: 10.1016/j.ejim.2008.08.006. Epub 2008 Sep 21.
To evaluate if consultation between specialists in Internal Medicine and family doctors (CIMFD) improves the clinical management and prognosis of patients with heart failure (HF).
prospective case-control study (5 years of follow-up).
community-based sample within the area of a university teaching hospital.
1857 patients (> or = 14 years) diagnosed for the first time with HF (1stDxHF), in the CIMFD.
1981 patients (from health centres not covered by the CIMFD), 1stDxHF, in the external consultations of the hospital.
mortality rate (MR). Admissions (HA). Emergency services visits (ESV). Delays in receiving specialist attention (DRSA), and the resolution of the process (DRP). Number (NTP) and delays in reporting (DTP) tests performed. Proportion (PRC) and delay (DRC) in resolving cases.
We observed a reduction of: MR (by 10.8%, CI 95%, 8.6-13.0, p < 0.005); HA, per patient per year (ppy) (by 1.8, 1.3-2.3, p < 0.01); ESV, ppy (by 1.9, 1.2-2.6, p < 0.01); DRSA (by 26.5 days, 21.8-31.2, p < 0.001); DRP (by 21.0 days, 18.3-23.7, p < 0.001), and DRC (by 25.8 days, 20.3-31.4, p < 0.01). The PRC (17.2%, CI 95%, 15.5-18.9, p < 0.01) was higher for the CIMFD.
The CIMFD approach improves prognosis and efficacy in the clinical management of patients with HF because it reduces mortality and morbidity (HA and ESV), shortens the delays in receiving care and in resolving the diagnostic and therapeutic process (DRSA, DRP, DRC), and increases the proportion of diagnosed and treated patients.
评估内科专家与家庭医生之间的会诊（CIMFD）是否能改善心力衰竭（HF）患者的临床管理及预后。
前瞻性病例对照研究（随访5年）。
大学教学医院所在区域内基于社区的样本。
1857例首次诊断为HF（首次诊断HF）的患者（年龄≥14岁），参与CIMFD。
1981例首次诊断HF的患者（来自未纳入CIMFD的健康中心），在医院外部会诊中。
死亡率（MR）、住院率（HA）、急诊就诊次数（ESV）、获得专科治疗的延迟时间（DRSA）、诊疗过程的解决时间（DRP）、所做检查的数量（NTP）及报告延迟时间（DTP）、病例解决比例（PRC）及延迟时间（DRC）。
我们观察到以下指标降低：MR（降低10.8%，95%置信区间，8.6 - 13.0，p < 0.005）；HA，每年每例患者（ppy）（降低1.8，1.3 - 2.3，p < 0.01）；ESV，ppy（降低1.9，1.2 - 2.6，p < 0.01）；DRSA（降低26.5天，21.8 - 31.2，p < 0.001）；DRP（降低21.0天，18.3 - 23.7，p < 0.001），以及DRC（降低25.8天，20.3 - 31.4，p < 0.01）。CIMFD的PRC更高（17.2%，95%置信区间，15.5 - 18.9，p < 0.01）。
CIMFD方法可改善HF患者临床管理的预后和疗效，因为它降低了死亡率和发病率（HA和ESV），缩短了获得治疗及解决诊断和治疗过程的延迟时间（DRSA、DRP、DRC），并提高了确诊和治疗患者的比例。
