Radboud University Nijmegen Medical Centre, Department of Primary and Community care, HB, The Netherlands.
BMC Fam Pract. 2012 Aug 20;13:86. doi: 10.1186/1471-2296-13-86.
A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients' experiences with continuity of care, and its relation to medication adherence.
We collected data from 327 primary care patients with chronic heart failure. Experienced continuity of care was measured using a patient questionnaire and by reviewing patients' medical records. Continuity of care was defined as a multidimensional concept including personal continuity (seeing the same doctor every time), team continuity (collaboration between care providers in general practice) and cross-boundary continuity (collaboration between general practice and hospital). Medication adherence was measured using a validated patient questionnaire. The relation between continuity of care and medication adherence was analysed by using chi-square tests.
In total, 53% of patients stated not seeing any care provider in general practice in the last year concerning their heart failure. Of the patients who did contact a care provider in general practice, 46% contacted two or more care providers. Respectively 38% and 51% of patients experienced the highest levels of team and cross-boundary continuity. In total, 14% experienced low levels of team continuity and 11% experienced low levels of cross-boundary continuity. Higher scores on personal continuity were significantly related to better medication adherence (p < 0.01). No clear relation was found between team- or cross-boundary continuity and medication adherence.
A small majority of patients that contacted a care provider in general practice for their heart failure, contacted only one care provider. Most heart failure patients experienced high levels of collaboration between care providers in general practice and between GP and cardiologist. However, in a considerable number of patients, continuity of care could still be improved. Efforts to improve personal continuity may lead to better medication adherence.
现在越来越多的医疗保健提供者参与到心力衰竭的治疗中。这可能导致治疗的不连续和碎片化，从而降低信任度，进而导致药物治疗的依从性更差。本研究旨在探讨心力衰竭患者的连续护理体验及其与药物治疗依从性的关系。
我们从 327 名慢性心力衰竭的初级保健患者中收集数据。使用患者问卷和查看患者病历来衡量连续护理的体验。连续性护理被定义为一个多维概念，包括个人连续性（每次都看同一位医生）、团队连续性（一般实践中护理提供者之间的协作）和跨边界连续性（一般实践与医院之间的协作）。使用经过验证的患者问卷来衡量药物治疗的依从性。通过使用卡方检验分析连续性护理与药物治疗依从性之间的关系。
总的来说，53%的患者表示在过去一年中没有就心力衰竭问题向任何一般实践护理提供者咨询过。在联系一般实践护理提供者的患者中，46%联系了两个或更多的护理提供者。分别有 38%和 51%的患者经历了最高水平的团队和跨边界连续性。总的来说，14%的患者经历了团队连续性低水平，11%的患者经历了跨边界连续性低水平。个人连续性得分越高，药物治疗的依从性越好（p < 0.01）。团队或跨边界连续性与药物治疗依从性之间没有明显的关系。
一小部分联系一般实践护理提供者治疗心力衰竭的患者只联系了一位护理提供者。大多数心力衰竭患者经历了一般实践护理提供者之间以及全科医生和心脏病专家之间的高水平协作。然而，在相当数量的患者中，连续性护理仍有待提高。努力提高个人连续性可能会导致更好的药物治疗依从性。
