Enhanced access to primary care for patients with congestive heart failure. Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.
Eff Clin Pract
; 2(5): 201-9, 1999.
Article
en En
| MEDLINE
| ID: mdl-10623052
ABSTRACT
OBJECTIVE:
To determine whether enhanced access to primary care affects the diagnostic evaluation, pharmacologic management, or health outcomes of patients hospitalized with congestive heart failure (CHF).DESIGN:
Multisite randomized, controlled trial.SETTING:
Nine Veterans Affairs medical centers. PATIENTS 443 patients who were hospitalized with a diagnosis of CHF. INTERVENTION Enhanced access to primary care, including assignment of a primary care nurse and physician, increased telephone contact, additional outpatient visits, and patient education. MAIN OUTCOMEMEASURES:
Diagnostic evaluation, pharmacologic management, health-related quality of life, and hospital readmission rates.RESULTS:
About 80% of patients who had enhanced access to care and patients receiving usual care underwent recommended evaluation of left ventricular ejection fraction. Among the subset of patients for whom an angiotensin-converting enzyme (ACE) inhibitor was recommended (i.e., ejection fraction < 40%), three quarters of the patients in both the enhanced access and usual care groups received the drug (75% vs. 73%; P > 0.2). Enhanced access to primary care did not improve quality of life and increased hospital readmissions, with an average of 1.5 +/- SD 2.0 readmissions per 6 months of follow-up for patients who had enhanced access compared with 1.1 +/- SD 1.8 for those who received usual care (P = 0.02).CONCLUSIONS:
Compliance with recommended CHF testing and treatment guidelines was equally high in both study groups. Enhanced access to primary care did not improve patients' self-reported health status and was associated with more frequent hospitalizations.
Buscar en Google
Bases de datos:
MEDLINE
Asunto principal:
Atención Primaria de Salud
/
Accesibilidad a los Servicios de Salud
/
Insuficiencia Cardíaca
Tipo de estudio:
Clinical_trials
/
Guideline
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Eff Clin Pract
Asunto de la revista:
SERVICOS DE SAUDE
Año:
1999
Tipo del documento:
Article
País de afiliación:
Estados Unidos