Introduction
The Heartbeat Trust has been at the forefront of the development of structured care programmes for the prevention and management of heart failure (HF), including a “virtual consultation” service to enable specialists and GPs to discuss cases and reduce the need for outpatient department referral. The Heart Failure Virtual Clinics (HFVC) are used to disseminate expert HF advice and education to GPs. Using a web conference platform GPs can log in remotely, following presentation of a short CME topic GPs can discuss their cases with Prof Ken McDonald, Consultant Cardiologist and Medical Director of the Heartbeat Trust, Dr Patricia Campbell, Consultant Cardiologist and their specialist team. The HFVCs provide online, real-time conversations between the GP and specialist allowing speedy focused interactions.
The HFVC has been running successfully as a service for twenty-four months. These virtual consultations are held bi-weekly from the Heartbeat Trust Offices/St Michaels Hospital and are currently on Tuesdays and Fridays at 1pm, having recently expanded into the Carlow Kilkenny region through support from the HSE. CME topics include (but are not limited to), Diagnosis of heart failure, Management of Stable heart failure, Troubleshooting medications in heart failure and other similar topics. Following the CME topic up to six cases are discussed which results in an intense hour of impartation of knowledge. Patient referrals are accepted through email/FAX and Healthlink, via the Heart Failure Virtual Clinic Referral tab.
In summary our aim is to reduce need for referral to outpatient department, increase confidence of GPs in managing heart failure in the community and improve GP-specialist team interaction
The Problem
One in 5 of us will develop heart failure in our lifetime. There are up to 90,000 people in Ireland living with Heart Failure and the estimated cost of Heart Failure is €660 million. Many challenges remain in the management of Heart Failure with suboptimal implementation of guideline-recommended therapies, a changing profile of patients who are older and have multiple comorbidities and a high rate of early re-hospitalization for heart failure. Use of modern communication systems has the potential to revolutionize primary care-secondary care interactions.
The Solution
Heart Failure, with the correct supports can largely be managed in the community. That’s where the Heartbeat Trust steps in with its innovative approach to health care management. For GPs, the HFVC provides a dynamic learning environment, improved knowledge base, peer to peer support and most importantly the necessary supports to maintain and treat heart failure patients in the primary care setting.
The application of this GP-specialist on line, real time can host at one sitting up to 25 GP practices, enabling specific case discussion but also a dissemination of practical tips in heart failure care. This strategy offers an alternative to standard clinic assessment, can provide the GP with all the information that he/she requires, reduce need for onward direct referral and thereby can reduce “unnecessary” travel for the patient and their family, a very meaningful bonus for this type of interaction given the age and frailty of many patients with heart failure. This intervention also provides a user-friendly method to update the care strategy for a patient without necessarily requiring the patient to travel and provide facilitated access for GPs to specialist diagnostics in a timely manner.
The Benefits
By managing heart failure in the community, the HFVC removes a step in the traditional care pathway facilitating interaction between the specialist/GP. The HFVC care pathway is cost efficient and creates a dynamic, collaborative communication environment compared to the traditional referral letter pathway. This in turn reduces costs and the need for patient travel and family inconvenience. Moreover, the HFVC reduces the need for Out Patient Department referrals which frees up hospital OPD slots for those in need of standard clinics resulting in shorter waiting times and speedier reviews.
Presently, there are 150 GPs signed up to date across the East Coast, Midlands and now Carlow Kilkenny region with 100% of GPs agreeing that the HFVC advice was useful in treating their patients and that the patients themselves benefited as a result of their participation in the HFVC. The patients themselves were also happy to have their conditions discussed with expert and groups of GPs and relieved to not be referred to the OPD. The Heartbeat Trust provide full training for first time users or those that require a refresher.
Over initial the 18 month study period 142 patients were referred to the service. Only 17% required review in the outpatient department with the majority of issues dealt with through the VC service. The travel distance saved for patients referred to this service was 10,552km. A total of 30 GP practices utilized the service during the study and 17 participated in a mixed methods study of the service. Usability and improvements in self reported efficacy were high for the GPs involved.
Next Steps
The Heartbeat Trust are passionate about the future advancement of eHealth in Ireland and are optimistic about the use of technology for wider dissemination of heart failure knowledge and community care. Resourcing of this method of integrated care is required to ensure that both specialist and GP teams can participate fully without compromising other patient care. The use of webconferencing is easily transferable to settings nationally.
You can find out more about the HeartBeat Trust on their website or on twitter @heartbeat_trust
