scholarly journals Management of atrial fibrillation and heart failure in outpatient settings

2021 ◽  
Author(s):  
◽  
Joselyn Law
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Treatment Options ◽  
Primary Care Providers ◽  
Complex Nature ◽  
Collaborative Approach ◽  
Care Providers ◽  
Comprehensive Search ◽  
Outpatient Settings

Atrial fibrillation (AF) and heart failure (HF) have a highly interconnected relationship with similar risk factors and shared pathophysiology. They often occur together and are associated with increased morbidity and mortality. Unfortunately, the presence of one condition has implications for the treatment of the other. Guidelines exist for each disease, however, do not provide clarity when treating the conditions together. Due to the complex nature of the combined diseases, management requires a systematic and collaborative approach in primary care settings. The integrative review seeks to explore the following question, “How can the nurse practitioner (NP) best manage HF patients with AF in outpatient settings to help reduce the burden on the healthcare system?” A comprehensive search of the literature was undertaken and 20 articles were selected based on the inclusion criteria. The review findings provide insight into the diverse treatment options available to persons living with concomitant AF and HF. From the literature, catheter ablation, an invasive and specialized procedure, emerged as a superior treatment strategy for patients with combined AF and HF, particularly when compared the pharmacotherapy of rate and/or rhythm control. The management of AF in the setting of HF requires a collaborative approach between primary care providers (PCP) as well as specialists that are able to help manage the population of interest, such as cardiologist and electrophysiologists. Recommendations for practice, education, research, and policy have been made to support the role of PCPs, including NPs, in the management of AF in the HF population.

scholarly journals Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

2020 ◽  
Vol 38 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Rebecca M. Crimmins ◽  
Lydia Elliott ◽  
Darren T. Absher
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Palliative Care ◽  
Patient Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Care Providers ◽  
Communication Time

Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

Integrating primary care and cancer care in survivorship: A collaborative approach.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 103-103 ◽  
Author(s):  
Jonathan Sussman ◽  
Mary L McBride ◽  
Jeffrey Sisler ◽  
Grace Kim ◽  
Laura Game ◽  
...  
Keyword(s):  
Primary Care ◽  
Vertical Integration ◽  
Cancer Care ◽  
Functional Integration ◽  
Primary Care Providers ◽  
Collaborative Approach ◽  
Survivorship Care ◽  
Care Providers ◽  
Clinical Integration ◽  
The Impact

103 Background: Primary care providers (PCPs) have an important role in the provision of survivorship care. While there is evidence to support the feasibility and safety of PCP-led survivorship care, there are gaps in knowledge about how to best integrate providers to support transitions, enhance quality of care, increase system efficiencies, and improve patient and provider satisfaction. Methods: A pan-Canadian study comprised of three projects has been initiated to address three key aspects of care integration, based on a previously described system performance framework. Functional integration will be studied through the evaluation of electronic survivorship care plans using a prospective cohort of breast and colorectal cancer patients with pre and post measures of knowledge, care coordination, and satisfaction. Vertical integration will be evaluated through a series of descriptive case studies to document structures and processes that are currently in place to support PCP re-referral to regional cancer centres. Clinical integration will be studied through the development and evaluation of an interspecialty survivorship training curriculum for oncology and family medicine trainees. Results: Functional integration: Development of an electronic platform for care plan outputs is complete. Two sites in Ontario (ON) and one in British Columbia (BC) have been selected to study the impact on 200 patients and their providers. Vertical integration: Using a study-specific interview guide, 48 semi-structured key informant interviews have been successfully conducted in ON; 15 interviews are planned for Manitoba (MB) and 15 for BC. Clinical Integration: a National Advisory Committee was established and needs assessments were performed with postgraduate program directors, cancer survivors, and trainees using online surveys and focus groups. A blended learning curriculum is being piloted in MB, ON, and BC in 2015. Conclusions: Integrating primary care and cancer care in survivorship requires a collaborative approach that begins in residency, supports PCPs with clear mechanisms for re-entry, and optimizes communication. This study will inform approaches to enhancing provider integration and survivorship care.

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management

2020 ◽  
Vol 44 (3) ◽  
pp. 451
Author(s):  
Victar Hsieh ◽  
Glenn Paull ◽  
Barbara Hawkshaw
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Integrated Care ◽  
Significant Proportion ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Model ◽  
Care Project ◽  
Effective Delivery

ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

scholarly journals B-AB05-02 FEASIBILITY OF A GROUP-BASED VIRTUAL ATRIAL FIBRILLATION MANAGEMENT TRAINING PROGRAM FOR PRIMARY CARE PROVIDERS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S8
Author(s):  
T. Jennifer Walker ◽  
Tanya Lulla ◽  
Tiffany Armbruster ◽  
Zack Deyo ◽  
Brittany Becker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Training Program ◽  
Management Training ◽  
Primary Care Providers ◽  
Care Providers

scholarly journals Depression in adolescence: a review

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Diogo Beirão ◽  
Helena Monte ◽  
Marta Amaral ◽  
Alice Longras ◽  
Carla Matos ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Care Providers ◽  
Scientific Data ◽  
Screening Tests ◽  
Medical Community ◽  
Main Body ◽  
Care Providers

Abstract Background Depression is a common mental health disease, especially in mid to late adolescence that, due to its particularities, is a challenge and requires an effective diagnosis. Primary care providers are often the first line of contact for adolescents, being crucial in identifying and managing this pathology. Besides, several entities also recommend screening for depression on this period. Thus, the main purpose of this article is to review the scientific data regarding screening, diagnosis and management of depression in adolescence, mainly on primary care settings. Main body Comprehension of the pathogenesis of depression in adolescents is a challenging task, with both environmental and genetic factors being associated to its development. Although there are some screening tests and diagnostic criteria, its clinical manifestations are wide, making its diagnosis a huge challenge. Besides, it can be mistakenly diagnosed with other psychiatric disorders, making necessary to roll-out several differential diagnoses. Treatment options can include psychotherapy (cognitive behavioural therapy and interpersonal therapy) and/or pharmacotherapy (mainly fluoxetine), depending on severity, associated risk factors and available resources. In any case, treatment must include psychoeducation, supportive approach and family involvement. Preventive programs play an important role not only in reducing the prevalence of this condition but also in improving the health of populations. Conclusion Depression in adolescence is a relevant condition to the medical community, due to its uncertain clinical course and underdiagnosis worldwide. General practitioners can provide early identification, treatment initiation and referral to mental health specialists when necessary.

scholarly journals Management of spinal disorders by primary care providers in Saudi Arabia: Treatment options and referral patterns

2015 ◽  
Vol 4 (3) ◽  
pp. 143 ◽  
Author(s):  
KhalidAbdulrazzak Alsaleh ◽  
AbdullahSaleh Alluhaidan ◽  
YazeedKhalid Alsaran ◽  
HeshamSaad Alrefayi ◽  
NizarAbdullah Algarni ◽  
...  
Keyword(s):  
Primary Care ◽  
Saudi Arabia ◽  
Treatment Options ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Spinal Disorders

Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners

2021 ◽  
Author(s):  
Sanjeev Sirpal ◽  
Natasha Chandok
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Economic Status ◽  
Treatment Options ◽  
Linkage To Care ◽  
Primary Care Providers ◽  
Community Context ◽  
World Health ◽  
Survey Study ◽  
Care Providers

Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth the by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers’ knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.

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