Mamataz Taslima, Fowokan Adeleke, Hajaj Ahmad Mohammad, Asghar Areeba, Abrahamyan Lusine, McDonald Michael, Harkness Karen, Grace Sherry L
Faculty of Health, York University, Toronto, Ontario, Canada.
KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2023 Mar 9;5(6):421-428. doi: 10.1016/j.cjco.2023.03.002. eCollection 2023 Jun.
Though heart failure patients benefit from multidisciplinary care in heart function clinics (HFCs), utilization is suboptimal and inequitable. This study investigated factors influencing referral and patient access to HFCs from multiple stakeholders' perspectives, namely policy-makers (PM), providers at HFCs and patients.
In this qualitative study, semi-structured interviews with a purposive sample of Ontario stakeholders were conducted between February-June 2020 and July-December 2022 (paused due to pandemic) via Teams. Interview transcripts were concurrently analyzed using systematic text condensation with Nvivo. Two authors coded individually, with disagreements discussed with senior author.
Interviews with 7 HFCs (6 physicians, 1 nurse), 6 PM and 4 patients were completed before saturation; 5 themes emerged. First, with regard to health system organization, stakeholders reported gaps related to continuity of care, limited capacity and insufficient funding. Second, with regard to referral appropriateness and timeliness, sub-themes related to unclear referral criteria, varying clinic scope, and delays in triage, testing and time-to-visit. The third theme related to clinic characteristics, raised issues of varying clinic services and composition of healthcare professions/expertise. The fourth theme regarding patient factors related to comorbidity/frailty, socioeconomic status, barriers due to location (parking, traffic) and affinity to specific providers. The final theme related to the COVID-19 pandemic concerned increased referral volumes, loss to follow-up care, transition to online delivery modalities and patient refusal of in-person visits. Many facilitators to improve HFC referral and access were raised.
Resources must be provided, and stakeholders brought together to standardize and integrate the HF care continuum.
尽管心力衰竭患者在心脏功能诊所（HFC）接受多学科护理可从中受益，但利用率仍不理想且存在不公平现象。本研究从多个利益相关者的角度，即政策制定者（PM）、HFC的提供者和患者，调查了影响转诊以及患者进入HFC的因素。
在这项定性研究中，于2020年2月至6月以及2022年7月至12月（因疫情暂停）通过Teams对安大略省有目的抽样的利益相关者进行了半结构化访谈。访谈记录同时使用Nvivo的系统文本浓缩法进行分析。两位作者分别编码，如有分歧则与资深作者讨论。
在饱和之前完成了对7个HFC（6名医生、1名护士）、6名政策制定者和4名患者的访谈；出现了5个主题。首先，在卫生系统组织方面，利益相关者报告了护理连续性、能力有限和资金不足方面的差距。其次，在转诊的适当性和及时性方面，子主题涉及转诊标准不明确、诊所范围不同以及分诊、检测和就诊时间延迟。第三个主题与诊所特征有关，提出了诊所服务不同以及医疗专业/专业知识构成方面的问题。第四个关于患者因素的主题涉及合并症/虚弱、社会经济地位、因地点（停车、交通）造成的障碍以及对特定提供者的偏好。与2019冠状病毒病大流行相关的最后一个主题涉及转诊量增加、失访、向在线提供方式的转变以及患者拒绝面对面就诊。提出了许多改善HFC转诊和就诊机会的促进因素。
必须提供资源，并让利益相关者共同努力，以规范和整合心力衰竭护理连续过程。
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