Cardiac Arrhythmia Service, St Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
Cardiac Arrhythmia Service, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre in the Li Ka Shing Institute of St Michael's Hospital, Toronto, Ontario, Canada.
Can J Cardiol. 2018 Sep;34(9):1219-1224. doi: 10.1016/j.cjca.2018.05.017. Epub 2018 May 28.
The increased prevalence of atrial fibrillation (AF) has led to specialized AF clinics (AFCs) to facilitate management of AF patients. In this article we report on outpatient AFCs in Canada, which is essential to health policies required to standardize the performance of existing AFCs and help design new AFCs. We surveyed 14 clinics in 5 provinces; 100% provided responses to a detailed questionnaire on clinic processes and care practices. Fourteen care maps were analyzed, and 5 models of care were identified; 4 were specific to AFCs. An online survey with 49 questions included items on: (1) process before visit; (2) process at visit; (3) patient education provided; (4) outreach; and (5) specific clinic information. Clinicians' advice to patients on self-care items such as: (1) amount of alcohol and (2) caffeine intake; (3) exercise activity; (4) stressful events; (5) "when to go to the emergency department"; and (6) lifestyle changes, were evaluated to assess consistency in practice. There were moderate variances in clinicians' advice to patients in 5 of 6 self-care items. The 1 item that had 100% consistent practice recommendation was when to go to the emergency department. A guideline-based clinical assessment checklist (CAC) was piloted to obtain feedback on its usability in real-world practice; revisions finalized the "simplified CAC" for AF care encompassing 35 data points with rationale. There was 100% positive feedback on its ability to provide baseline elements in AF care. When validated, a "simplified CAC" can facilitate a standardized clinical assessment tool in clinical practice.
心房颤动 (AF) 的患病率不断增加，导致专门的 AF 诊所 (AFC) 得以成立，以方便 AF 患者的管理。本文报告了加拿大的门诊 AFC 情况，这对于制定规范现有 AFC 性能并帮助设计新 AFC 的卫生政策至关重要。我们调查了 5 个省的 14 个诊所；所有诊所均 100% 对关于诊所流程和护理实践的详细问卷做出了回应。分析了 14 份护理图，并确定了 5 种护理模式；其中 4 种专门针对 AFC。一项包含 49 个问题的在线调查包括：(1) 就诊前流程；(2) 就诊时流程；(3) 提供的患者教育；(4) 外展服务；以及 (5) 特定的诊所信息。临床医生就以下自我护理项目向患者提供建议：(1) 酒精和 (2) 咖啡因摄入量；(3) 运动活动；(4) 压力事件；(5)“何时去急诊室”；以及 (6) 生活方式改变，评估实践中的一致性。在 6 项自我护理项目中的 5 项中，临床医生向患者提供的建议存在中度差异。在需要去急诊室的建议中，有 100% 的一致性。基于指南的临床评估检查表 (CAC) 进行了试点，以获取其在真实实践中的可用性反馈；修订后的“简化 CAC”涵盖了涵盖 35 个数据点和基本原理的 AF 护理，最终定稿。它在提供 AF 护理基本要素方面获得了 100% 的正面反馈。经验证后，“简化 CAC”可以在临床实践中为标准化临床评估工具提供便利。
