Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study

Abstract

Background: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management. Objectives: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland. Methods: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year’s CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected. Results: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (≥80 years) than in the younger ones (respectively 50% versus 72%, Ρ <0.001) and in women than in men (62% versus 71%, P <0.001). The percentage of the patients treated with β-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared. Conclusion: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience of Spanish primary care providers handling uncertainty and patients’ requests

“…The immediate causes of overuse include 10–15 insufficient updating of knowledge by professionals, defensive medicine, the custom of doing things that have always been done, lack of time in consultation, inadequate incentives, influence by the pharmaceutical industry and inadequate communication with patients. Patients requesting diagnostic tests 9 16 17 or treatments based on personal beliefs or from information obtained by other patients or from the internet 9 18 19 have been also identified as a cause of overuse.…”

“…Patients in primary care usually request diagnostic tests, referrals to specialists and medications, more frequently antimicrobials and for reducing pain. 9 20 These requests generate dissatisfaction and make professionals uncomfortable 21 because they call their clinical expertise into question, 22 and this affects the quality of the relationship with the patient. Primary care physicians accept and handle the relationship with the patient better in the case of requests for tests and referrals to specialists than when the patient requests certain medications.…”

“… 24 Other drivers of medical overuse from a primary care perspective also includes the lack of communication skills or medical work experience, insufficient time during consultation and fear of malpractice. 9 24 25 …”

Comprehensive Women Health Services at Beverage-Producing Industries of Limpopo (South Africa): Women’s Perspective

“…Trustworthiness of the project was ensured by applying the following criteria: Credibility was ensured by investing sufficient time in the research field to become familiar with the setting and context, and to get rich information through prolonged engagement with the participants [ 26 ]. A thick description of the study context, research methods, and the experiences of the women was done to ensure transferability [ 24 ] An audit trail was done by the co-researchers to ensure dependability and confirmability [ 21 ].…”

Feasibility of Using a Pocket-Sized Ultrasound Device to Measure the Inferior Vena Cava Diameter of Patients With Heart Failure in the Community Setting: A Pilot Study

“…Handheld portable ultrasound examination by nonphysician providers is helpful in the management of many health problems, including rheumatic heart disease, 6 maternity care, 7 peripheral intravenous catheter placement, 8 pressure ulcer, 9 and heart failure. 10,11 The IVC diameter and its change with respiratory variation is a marker of right atrial pressure 12 and potentially a significant parameter for assessing temporal changes in the fluid status of a home patient with heart failure. IVC diameter is merely one piece of data that community nurses should employ in assessing the volume status of home-dwelling patients with heart failure.…”