RESUMEN
Non-attendance reduces clinic and provider productivity and efficiency, compromises access and increases cost of health care. This systematic review of the English language literature (November 1999-November 2009) compares telephone, mail, text/short message service, electronic mail and open-access scheduling to determine which is best at reducing outpatient non-attendance and providing net financial benefit. Telephone, mail and text/short message service interventions all improved attendance modestly but at varying costs. Text messaging was the most cost-effective of the 3, but its applicability may be limited. Few data are available regarding electronic mail reminders, whereas open-access scheduling is an area of active research.
Asunto(s)
Citas y Horarios , Cooperación del Paciente , Sistemas Recordatorios , Humanos , Evaluación de Programas y Proyectos de Salud , Sistemas Recordatorios/economíaRESUMEN
Evidence-based management of chronic systolic heart failure includes risk factor management, therapeutic lifestyle changes, and a polypharmaceutical regimen that prolongs survival, reduces or reverses progression of myocardial dysfunction, alleviates symptoms, and limits complications. Subspecialty consultation is warranted when symptoms progress despite standard therapy; interventions are needed for refractory coronary disease, an arrhythmia device is indicated, or surgical intervention or transplantation is considered.
Asunto(s)
Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca Sistólica/terapia , Atención Ambulatoria/métodos , Cardiología/métodos , Fármacos Cardiovasculares/efectos adversos , Enfermedad Crónica , Práctica Clínica Basada en la Evidencia , Insuficiencia Cardíaca Sistólica/tratamiento farmacológico , Humanos , Derivación y Consulta , Conducta de Reducción del RiesgoRESUMEN
More patients are both suffering and surviving acute coronary syndromes. After hospital discharge, a host of interventions, including medications, therapeutic lifestyle changes, revascularization, and electrophysiologic devices improve quality of life and survival. Evidence-based management requires the general internist to have a working knowledge of these interventions and to identify patients whose outcomes would benefit from subspecialty referral.