Kugathasan Lakshmi, Francis Troy, Rac Valeria E, Wijeysundera Harindra C, McDonald Michael, Ross Heather J, Alba Ana Carolina
Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada.
CJC Open. 2021 Mar 26;3(7):929-935. doi: 10.1016/j.cjco.2021.03.010. eCollection 2021 Jul.
Multidisciplinary heart failure (HF) clinics decrease hospital admission rates and healthcare use, while improving patient outcomes. To understand the contemporary availability of HF clinics in Ontario, Canada, and the services provided, we performed an environmental scan of physician-led and nurse practitioner (NP)-led HF clinics.
Between November, 2019 and February 2020, we identified Ontario HF clinics led by physicians or NPs. Following an invitation, we conducted a semi-structured interview to evaluate the services offered and qualitatively compared our findings to the results of the 2010 Ontario provincial survey.
The number of HF clinics (36 vs 34 in 2010) and physicians (157 vs 143 in 2010) have not changed since the 2010 survey. Of the 36 clinics we identified, 30 participated in our interview (22 physician-led and 8 NP-led). Twenty-five clinics (83%) were hospital-based, of which 9 (30%) were part of an academic institution. Comparisons of our findings to the 2010 study on 30 clinics show an approximately 3-fold increase ( <0.001) in both median annual and new patient visits. As previously reported, the clinics varied in services offered, but trended toward an increased availability of onsite echocardiography, exercise-stress testing, and nuclear cardiology.
Compared to the survey performed a decade ago, the number of HF clinics and physicians have not changed, and the services provided remain heterogenous. However, the increased number of patients served suggests a greater demand for these clinics. Improving the accessibility of these clinics and standardizing the service model are critical to improving patient outcomes.
多学科心力衰竭（HF）诊所可降低住院率和医疗保健利用率，同时改善患者预后。为了解加拿大安大略省HF诊所的当前可及情况以及所提供的服务，我们对由医生主导和执业护士（NP）主导的HF诊所进行了一项环境扫描。
在2019年11月至2020年2月期间，我们确定了安大略省由医生或NP主导的HF诊所。在发出邀请后，我们进行了半结构化访谈，以评估所提供的服务，并将我们的研究结果与2010年安大略省省级调查的结果进行定性比较。
自2010年调查以来，HF诊所的数量（2010年为34家，现为36家）和医生数量（2010年为143名，现为157名）均未改变。在我们确定的36家诊所中，有30家参与了我们的访谈（22家由医生主导，8家由NP主导）。25家诊所（83%）设在医院内，其中9家（30%）是学术机构的一部分。将我们对30家诊所的研究结果与2010年的研究进行比较，发现年度中位数就诊次数和新患者就诊次数均增加了约3倍（<0.001）。如先前报道的那样，各诊所提供的服务各不相同，但现场超声心动图、运动负荷试验和核心脏病学检查的可及性有增加的趋势。
与十年前进行的调查相比，HF诊所的数量和医生数量没有变化，所提供的服务仍然参差不齐。然而，就诊患者数量的增加表明对这些诊所的需求更大。提高这些诊所的可及性并规范服务模式对于改善患者预后至关重要。
