J Cardiovasc Nurs. 2024;39(1):18-30. doi: 10.1097/JCN.0000000000001029.
Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics.
The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic.
An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale.
Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals ( P s < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns).
Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.
心力衰竭 (HF) 护理提供者是患者获得救命 HF 诊所适当服务的把关人。
本研究旨在调查转诊提供者对 HF 诊所转诊的看法，包括提供者专业和冠状病毒病大流行的影响。
这是一项混合方法研究，采用探索性、顺序设计。在定性阶段，对安大略省符合转诊条件的 HF 提供者（即执业护士、心脏病专家、内科医生、初级保健和急诊医生）进行了有针对性的半结构式访谈。访谈通过 Microsoft Teams 进行。研究人员使用 NVivo 软件对 2 名研究人员独立进行的转录本进行了分析，使用的是演绎主题方法。然后，通过 REDCap（研究电子数据捕获）对加拿大各地的类似提供者进行了横断面调查，使用了经修改的心脏康复和转诊提供者态度量表。
对 7 名提供者进行访谈后达到了饱和。出现了 4 个主题：对诊所及其特点的了解、提供者的临床专业知识、与患者的沟通和关系，以及诊所转诊流程和护理连续性。73 名提供者完成了调查。影响转诊的主要负面因素是对诊所益处的怀疑（4.1 ± 0.9/5）、患者体验不佳和认为他们更有能力管理患者（均为 3.9）。心脏病专家更强烈地认可转诊标准明确、转诊为规范和实践内转诊支持有助于适当转诊，而其他专业人员则不然（ P 值均<0.02），以及其他差异。三分之一（n = 13）的人报告说，大流行影响了他们的转诊做法（例如，限制了面对面护理、患者的担忧）。
尽管存在一些合理的适当诊所转诊障碍，但更多的提供者教育和支持可以促进患者的最佳就诊。
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