Adherence to guidelines in ambulatory patients with mild heart failure and associated organisational factors
Projectomschrijving
Chronisch hartfalen is een ongeneeslijke hartziekte waarbij de pompkracht van het hart geleidelijk afneemt. De behandeling bestaat uit diverse medicijnen en leefstijladviezen die vermeld staan in diverse richtlijnen voor zorgverleners. Hoe beter de behandeling verloopt volgens deze richtlijnen, des te beter lukt het om opname van de patiënt in het ziekenhuis te voorkomen en des te kosteneffectiever is de zorg voor mensen met hartfalen. In Nijmegen is geïnventariseerd hoe goed de zorgverleners de richtlijnen voor de behandeling van hartfalen opvolgen. Hiervoor zijn de behandelgegevens bestudeerd van 551 patiënten met hartfalen, afkomstig uit 42 huisartsenpraktijken. Hieruit blijkt onder andere dat de aanbevolen doses medicijnen zelden worden gehaald. Ook krijgt minder dan de helft van de patiënten advies over lichamelijke inspanning of het advies het water- en zoutgebruik te verminderen. Weinig huisartspraktijken beschikken over speciale hart- en vaatziektenspreekuren. De conclusie luidt dat de behandeling van chronisch hartfalen ruimte tot verbetering biedt.
Verslagen
Eindverslag
Samenvatting van de aanvraag
Background: Recent guidelines describe optimal clinical care for patients with chronic heart failure. Co-ordinated disease management may be cost-effective in this group, particularly because these programmes reduce numbers and length of hospitalisations. Many ambulatory patients with mild heart failure receive care in different settings simultaneously or intermittedly. Information and education of care providers related to the guidelines is needed, but actual adherence to recommendations in the guidelines is also determined by organisational factors. Research questions: The proposed cohort study aims to provide insight into current practice, estimate potential efficiency of improved guideline implementation, and examine organisational factors associated with better implementation. Design: Prospective observational study. Study population: A total of 200 patients with mild chronic heart failure (diagnosis by GP) will be recruited through 40 general practices and followed for 12 months. An experimental intervention or implementation strategy is not planned. Outcome and process measures: Primary health outcomes are mortality, hospital admission and patient reported quality of life. Items of medical care received by patients (process indicators) will be documented with structured forms on the basis of medical records in general practice. An economic evaluation examines the potential efficiency of improved adherence to guidelines. Organisational factors are based on theories on disease management, organisational culture and economic theory. Short questionnaires will be administered in care providers to documents these factors. Power/data-analysis: The study is powered to provide percentages with an accuracy of at least 8%. Descriptive and multilevel regression analyses will be performed. Health outcomes and process indicators, reflecting guideline adherence, are dependent factors in these analyses. Economic evaluation: The potential cost-effectiveness of optimal guideline implementation will be estimated by comparing patients who received optimal clinical care with patients who received less than optimal care with respect to costs and outcomes. A multilevel analysis will be used with both total Qualys lived and total medical cost per patient during the observation period as dependent. Time schedule: Month 1-6 elaboration of instruments, practice recruitment. Month 7-20: Inclusion of patients, measurements. Month 21-24: Data analysis, economic evaluations, report.