Barriers to care in urban and rural dwelling adults with congenital heart disease

McGrath, Lidija; Taunton, Marshall; Levy, Sheldon; Kovacs, Adrienne H.; Broberg, Craig S.; Khan, Abigail

doi:10.1017/s1047951121002766

Cited by 13 publications

(4 citation statements)

References 15 publications

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“…In our analysis, patients with Medicaid insurance had an increased likelihood of returning to a primary care clinic or to the ED after loss to cardiology follow-up, which reveals an opportunity to recontact these patients and re-enroll them into cardiology care. Patients living in rural areas are more likely to cite distance to care and loss of income related to taking time off work as signi cant barriers to maintaining continuity of care [14]. Similarly, in our study, patients who live further from the clinic were less likely to be seen again in primary care clinics, subspecialty clinics, or the ED after loss to cardiology follow-up.…”

Section: Discussionmentioning

confidence: 48%

Health system encounters after loss to cardiology follow-up among patients with congenital heart disease

Wright¹,

Fassler

Tumin

et al. 2022

Preprint

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Objectives Many patients with congenital heart disease (CHD) are lost to cardiology follow-up, but may continue to receive care from other clinics or facilities in the same health system. We analyzed receipt of care at other locations within a single rural academic health system after loss to follow-up in a pediatric cardiology clinic. Material and methods Patients with CHD seen in the clinic during 2018 and subsequently lost to cardiology follow-up were included in the study. Subsequent visits to other locations, including other subspecialty clinics, primary care clinics, the emergency department (ED), and the hospital, were tracked through 2020. Results Of 235 patients (median age 7 years, 136/99 female/male), 96 (41%) were seen elsewhere in the health system after loss to cardiology follow-up, most commonly by other subspecialty clinics or in the ED. Patients with medical comorbidities, Medicaid insurance, and those living closer to the clinic were most likely to continue receiving care within the same health system. Conclusions Patients with CHD are frequently lost to cardiology follow-up. Our study supports collaboration across specialties and between cardiology clinics and affiliated EDs to identify patients with CHD who have been lost to cardiology follow-up but remain in contact with the health system. A combination of in-person and remote outreach to these patients may help them re-establish cardiology care.

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Section: Discussionmentioning

confidence: 48%

Health system encounters after loss to cardiology follow-up among patients with congenital heart disease

Wright¹,

Fassler

Tumin

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, it is essential to check one’s body weight regularly, as this can indicate water retention in case of decompensated heart failure before more pronounced symptoms such as shortness of breath or a decrease in physical performance occur. Telemedicine offers excellent opportunities to provide urgently needed care, especially in medically underserved areas or, as recently, during the COVID-19 pandemic [ 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review

Stremmel¹,

Breitschwerdt²

2023

JMIR Cardio

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Background The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. Objective After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). Methods We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. Results Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. Conclusions Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.

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“…Australia is fortunate as there is a universal health insurance scheme which may be further supplemented by private health insurance. While rural patients face additional challenges due to greater traveling distance for appointments and the increased time off work, 30 there is no clear answer to the paucity of ACHD for rural areas, suggesting the need for outreach clinics outside major centers, already underway in New South Wales and Victoria.…”

Section: Commentmentioning

confidence: 99%

How do Adults With Congenital Heart Disease Evaluate Their Clinical Care?

Wijayarathne

Menahem

2023

World J Pediatr Congenit Heart Surg

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Background Almost 90% of patients with congenital heart disease (CHD) now reach adulthood. How do they evaluate the care they received? Methods Adults with CHD (ACHD) recruited for an international multi-center study (APPROACH-IS II) were posed 3 additional “questions” to determine their perceptions of the positive, negative, and areas for improvement of their clinical care. The findings underwent a thematic analysis. Results Of the 210 recruited, 183 completed the questionnaire, 147 answered the 3 “questions.” Most appreciated open communication and support, a holistic approach, continuity of and readily accessible care conducted by experts, and with good outcomes. Less than half reported negative concerns which included loss of autonomy, distress from multiple and/or painful investigations, restricted lifestyles, medication side-effects, and anxiety about their CHD. Others found their reviews time-consuming with long travel times. Some complained of limited support, poor accessibility to services in rural areas, shortage of ACHD specialists, absence of tailored rehabilitation programs, and at times their own as well as their clinicians’ limited understanding of their CHD. Suggestions for improvement included better communication, further education about their CHD, availability of simplified written information, mental health and support services, support groups, seamless transition to adult care and providing better prognostications, financial assistance, flexible appointments, telehealth reviews, and greater access to rural specialist care. Conclusions In addition to providing optimal medical and surgical care for ACHD, clinicians need to be cognizant of their patients’ concerns and proactive in addressing them.

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Barriers to care in urban and rural dwelling adults with congenital heart disease

Cited by 13 publications

References 15 publications

Health system encounters after loss to cardiology follow-up among patients with congenital heart disease

Health system encounters after loss to cardiology follow-up among patients with congenital heart disease

Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review

How do Adults With Congenital Heart Disease Evaluate Their Clinical Care?

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