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新型心力应激反应(CORS)试验增强初级保健中心心力衰竭诊断的机遇与挑战:定性研究。

Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study.

机构信息

Cardiovascular Research Centre, Newcastle University, Newcastle, UK.

Institute of Health and Society, Newcastle University, Newcastle, UK.

出版信息

BMJ Open. 2019 Apr 14;9(4):e028122. doi: 10.1136/bmjopen-2018-028122.

Abstract

OBJECTIVE

To explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.

DESIGN

Qualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.

SETTING

Newcastle upon Tyne, UK.

PARTICIPANTS

Fourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).

RESULTS

Four themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.

CONCLUSION

The development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

摘要

目的

探讨新型心力应激反应(CORS)测试在心力衰竭当前诊断路径中的作用,以及其在初级保健中应用的机遇和挑战。

设计

使用半结构化深入访谈的定性研究,对访谈进行音频记录并逐字转录。使用归纳法对访谈数据进行主题分析。

地点

英国泰恩河畔纽卡斯尔。

参与者

来自初级保健(全科医生(GP)、护士、医疗助理、执业经理)和二级保健(顾问心脏病专家)的 14 名医疗保健专业人员(6 名男性,8 名女性)。

结果

确定了与新诊断技术实施相关的机遇和挑战的四个主题。这些主题反映了 CORS 测试的采用将是初级保健的优势,但该测试的实施存在障碍,包括:临床实用性的建立、不适合行动不便的患者以及对全科医生实践的成本影响。

结论

开发一种简单的非侵入性临床测试,以加速心力衰竭在初级保健中的诊断,可能有助于减少向二级保健的不必要转诊。CORS 测试有可能满足这一需求;然而,必须充分探讨成本效益、诊断准确性和在初级保健中的无缝实施等因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cdd/6500186/03f866327e0d/bmjopen-2018-028122f01.jpg

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