Falces Carlos, Andrea Rut, Heras Magda, Vehí Cristina, Sorribes Marta, Sanchis Laura, Cevallos Joaquim, Menacho Ignacio, Porcar Sílvia, Font David, Sabaté Manel, Brugada Josep
Servicio de Cardiología, Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
Rev Esp Cardiol. 2011 Jul;64(7):564-71. doi: 10.1016/j.recesp.2011.02.021. Epub 2011 Jun 2.
To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools.
Observational, cross-sectional study of 2 series of chronic outpatients: conventional and integrated care. We analyzed patient distribution and the impact on good clinical practice indicators in patients with ischemic heart disease, heart failure and atrial fibrillation, along with primary care practitioner satisfaction and use of resources.
We included 3194 patients (1572 usual care, 1622 integrated care). Integrated care changed the patient distribution, allowing the cardiologist to focus on serious pathologies while cardiovascular risk factors and stable patients were monitored in primary care. In ischemic heart disease, improvement was observed in cholesterol management and blood pressure control; optimal medical treatment was more frequently prescribed and ventricular function evaluated more often. In heart failure, β-blockers treatment increased and functional class was assessed more often. In atrial fibrillation, an increase in anticoagulation prescription and echocardiography evaluation was observed. Satisfaction parameters improved with integrated care. The use of resources was not increased.
Using our integration model, follow-up and chronic treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were improved. Monitoring of chronic patients was redistributed between primary care and cardiology, and family physicians' satisfaction levels improved. There was no increase in use of resources. Full English text available from: www.revespcardiol.org.
评估一项将心脏病学与初级保健整合到临床实践中的项目与常规护理相比的影响。整合护理包括在每个初级保健诊所配备一名医院心脏病专家、共享临床病史、联合实践指南、咨询会议以及其他协调工具。
对两组慢性门诊患者进行观察性横断面研究：常规护理组和整合护理组。我们分析了患者分布情况以及该项目对缺血性心脏病、心力衰竭和心房颤动患者良好临床实践指标的影响，同时评估了初级保健医生的满意度和资源使用情况。
我们纳入了3194例患者（1572例接受常规护理，1622例接受整合护理）。整合护理改变了患者分布，使心脏病专家能够专注于严重病症，而心血管危险因素和病情稳定的患者则在初级保健机构接受监测。在缺血性心脏病方面，胆固醇管理和血压控制得到改善；更频繁地开具了最佳药物治疗处方，且更频繁地评估心室功能。在心力衰竭方面，β受体阻滞剂治疗增加，且更频繁地评估心功能分级。在心房颤动方面，抗凝处方和超声心动图评估有所增加。整合护理使满意度参数得到改善。资源使用并未增加。
采用我们的整合模式，缺血性心脏病、心力衰竭和心房颤动患者得到了更好的随访和长期治疗。慢性病的监测在初级保健和心脏病学之间重新分配，家庭医生的满意度有所提高。资源使用没有增加。全文可从以下网址获取：www.revespcardiol.org 。
