University of Ottawa, Regional Geriatric Program of Eastern Ontario, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
Arch Gerontol Geriatr. 2010 Mar-Apr;50(2):165-70. doi: 10.1016/j.archger.2009.03.004. Epub 2009 Apr 29.
HF is a leading health care concern, often under-recognized and under-treated in older women. Management of this complex condition frequently requires a multidisciplinary approach and a clinical pathway can be used to deliver coordinated care. This report is based on the intervention/treatment arm (n = 45) of a randomized controlled trial in older women who participated in a multidisciplinary clinic. We describe the development of a clinical pathway for HF and the variance reporting including factors affecting adherence with the pathway. Variances are patient or staff actions that did not meet the expected outcomes. Of the 45 intervention arm female patients, 5 were able to fully complete the program, meaning that all of the intended 12 visits were completed successfully. Thirteen women missed more than three clinic visits, and the rest attended most visits. Variance tracking identified that visits were interrupted most often by patient-related health issues, such as fatigue and pain, which may not be surprising given the expected multiple co-morbidities in this population. Transportation problems were identified as a barrier to attendance. Our study demonstrates that a clinical pathway can be implemented in an older, female population with HF. This report identifies some of the challenges and provides future recommendations for prospective pathway development.
HF 是一个主要的医疗保健问题，在老年女性中常常未被识别和治疗。这种复杂疾病的管理通常需要多学科方法，并且可以使用临床路径来提供协调的护理。本报告基于参与多学科诊所的老年女性的随机对照试验的干预/治疗臂（n = 45）。我们描述了 HF 临床路径的制定以及变异性报告，包括影响遵循路径的因素。变异性是指不符合预期结果的患者或工作人员的行为。在 45 名干预组女性患者中，有 5 人能够完全完成该计划，这意味着成功完成了所有预期的 12 次就诊。有 13 名女性错过了超过 3 次就诊，其余大部分都参加了就诊。变异性跟踪发现，就诊最常被与患者相关的健康问题打断，例如疲劳和疼痛，考虑到该人群中预期的多种合并症，这可能并不奇怪。交通问题被确定为参加的障碍。我们的研究表明，可以在患有 HF 的老年女性人群中实施临床路径。本报告确定了一些挑战，并为未来的路径开发提供了建议。
