PRIMARY
CARE AND HOSPITAL OUT-PATIENT USAGE BY PATIENTS WITH SEVERE HEART FAILURE S P Wright*, A Pearl+, G Gamble, H Walsh, N Sharpe and R N Doughty Dept of Medicine and Dept of General Practice and Primary Health Care+,
University of Auckland. Background: Heart failure (HF) is
a major public health problem, resulting in frequent hospital admissions,
extensive health expenditure and significant personal morbidity. In New
Zealand, primary care is funded by a combination of patient fee-for-service and
a government-funded per-patient subsidy. Little is known about the use of
primary healthcare resources by HF patients. The aims of this study were to
describe the frequency and determinants of GP and hospital out-patient clinic
(OPC) visits by a cohort of patients with HF. Methods:
The patients in this study were a prospectively-identified cohort of HF
patients enrolled in a clinic-based HF management programme which had no effect
on GP visits. The number and cause of all GP consultations and hospital
out-patient clinic (OPC) visits over one year were collected by primary care
record and hospital chart review. Determinants of visit frequency were
investigated using non-parametric (Wilcoxon) techniques and multiple
regression. Associations between GP visits, HF clinic attendance, OPC
attendance and inpatient hospital admissions were also investigated. Results:
197 patients were included in the study. Mean age 73 yrs (range 34 to 92), 40%
female, 55% patients had one or more previous admissions with HF. Over one year,
the median number of GP consultations was 14 (IQR 8, 19). The maximum number of
GP visits in one year was 38. The median number of hospital out-patient visits
was 2 (IQR 0, 4) with a range of 0 to 14. Determinants of a higher rate of
hospital out-patient visits on multivariate analysis included number of
previous admissions with heart failure, and concomitant diagnoses of ischaemic
heart disease or diabetes. No clinical, demographic or concomitant disease
variables independently effected the rate of GP consultations. GP visits had no
relationship to visits to the dedicated HF clinic, hospital out-patient visits
or in-patient admissions. Conclusions: Primary care use among patients
with HF is extensive and very frequent. The rate of GP visits cannot be predicted
by socio-demographic and clinical variables. Research is required to
investigate the utility of GP visits and the potential role of
primary-secondary care integration strategies.
