Physicians' view of primary care-based case management for patients with heart failure: a qualitative study

Peters-Klimm, Frank; Olbort, Rebecca; Campbell, Stephen; Mahler, Cornelia; Miksch, Antje; Baldauf, Annika; Szécsényi, Joachim

doi:10.1093/intqhc/mzp032

Cited by 23 publications

(34 citation statements)

References 27 publications

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“…Physician participants in focus groups in Germany did express positive attitudes toward delegating to medical assistants the responsibility of monitoring heart failure patients through phone calls and home visits. 23 One limitation of this qualitative study was the small sample size compared with the number of clinicians who had patients enrolled in the TTT study. Nevertheless, given the range in years of practice for the focus group participants, we feel that their acceptance of the intervention, especially their appreciation of the health coaches, was representative of the entire group of eligible clinicians.…”

Section: Discussionmentioning

confidence: 99%

Delegating Responsibility from Clinicians to Nonprofessional Personnel: The Example of Hypertension Control

Margolius

Wong²,

Goldman³

et al. 2012

The Journal of the American Board of Family Medicine

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Background: Involving nonclinician personnel in the treatment of hypertension may provide a solution to improve blood pressure control; however, this team-based approach cannot be implemented without first determining clinicians' willingness to delegate patient care to nonclinician team members. This study explores clinicians' perspectives on working with nonclinicians trained as "health coaches" to address medication adherence and lack of medication intensification among low-income patients with uncontrolled hypertension.Methods: We used a qualitative research approach to determine clinicians' opinions on the Treat-toTarget study, an intervention to improve blood pressure control. We conducted focus groups with clinicians who practice family medicine in a safety net clinic. Transcripts were analyzed using thematic content analysis.Results

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Section: Discussionmentioning

confidence: 99%

Delegating Responsibility from Clinicians to Nonprofessional Personnel: The Example of Hypertension Control

Margolius

Wong²,

Goldman³

et al. 2012

The Journal of the American Board of Family Medicine

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“…the integration of practice nurses in the chronic care model [17] or in case management models for specific indications, e.g. heart failure [18]. The patients' acceptance of such new models of organizing primary care is generally quite good [13,14].…”

Section: Discussionmentioning

confidence: 99%

Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre

Berg

Meinke

Matzke

et al. 2010

BMC Health Serv Res

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BackgroundAgainst the background of a decreasing number of general practitioners (GPs) in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention) supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany.To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county.MethodsInformation about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region.ResultsWithin the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together) did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits.ConclusionThe results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits.

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“…As such, qualitative methodologies were undertaken alongside the trial, to provide supplementary evidence [17,19]. The trial conformed to the principles outlined in the Declaration of Helsinki [20] and was approved by the institutional review boards of the local medical faculty of the university and the Medical Association of the federal state Baden-Württemberg in Germany.…”

Section: Methodsmentioning

confidence: 99%

Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

Peters-Klimm

Campbell

Hermann

et al. 2010

Trials

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BackgroundChronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs).MethodsThis patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models.ResultsBaseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]).ConclusionsIn this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case management showed no improved health outcomes or health care utilisation. However, case management significantly improved performance and key intermediate outcomes. Our study provides evidence for the feasibility of the case management model.Trial registration numberISRCTN30822978

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Physicians' view of primary care-based case management for patients with heart failure: a qualitative study

Cited by 23 publications

References 27 publications

Delegating Responsibility from Clinicians to Nonprofessional Personnel: The Example of Hypertension Control

Delegating Responsibility from Clinicians to Nonprofessional Personnel: The Example of Hypertension Control

Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre

Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

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