Key result
Interviews with 17 stakeholders identified 5 themes affecting heart function clinic access, including health system gaps, referral delays, clinic variations, patient barriers, and pandemic impacts.
Why the study?
Heart failure patients benefit from multidisciplinary care in heart function clinics, but utilization remains suboptimal and inequitable.
Qualitative interviews identified multiple systemic, clinic-level, and patient-level barriers to accessing multidisciplinary heart function clinics, highlighting the need for standardized care pathways.
Barriers to HFC access span system, clinic, and patient levels; hypothesis-generating for standardized pathways and future trials.
Background: Though heart failure patients benefit from multidisciplinary care in heart function clinics (HFCs), utilization is suboptimal and inequitable. This study investigated factors influencing referral and patient access to HFCs from multiple stakeholders' perspectives, namely policy-makers (PM), providers at HFCs and patients. Methods: In this qualitative study, semi-structured interviews with a purposive sample of Ontario stakeholders were conducted between February-June 2020 and July-December 2022 (paused due to pandemic) via Teams. Interview transcripts were concurrently analyzed using systematic text condensation with Nvivo. Two authors coded individually, with disagreements discussed with senior author. Results: Interviews with 7 HFCs (6 physicians, 1 nurse), 6 PM and 4 patients were completed before saturation; 5 themes emerged. First, with regard to health system organization, stakeholders reported gaps related to continuity of care, limited capacity and insufficient funding. Second, with regard to referral appropriateness and timeliness, sub-themes related to unclear referral criteria, varying clinic scope, and delays in triage, testing and time-to-visit. The third theme related to clinic characteristics, raised issues of varying clinic services and composition of healthcare professions/expertise. The fourth theme regarding patient factors related to comorbidity/frailty, socioeconomic status, barriers due to location (parking, traffic) and affinity to specific providers. The final theme related to the COVID-19 pandemic concerned increased referral volumes, loss to follow-up care, transition to online delivery modalities and patient refusal of in-person visits. Many facilitators to improve HFC referral and access were raised. Conclusions: Resources must be provided, and stakeholders brought together to standardize and integrate the HF care continuum.
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Mamataz et al. (2023) studied Heart failure (n=17). Factors influencing referral and patient access to heart function clinics was evaluated on Themes affecting referral and patient access to heart function clinics. Interviews with 17 stakeholders identified 5 themes affecting heart function clinic access, including health system gaps, referral delays, clinic variations, patient barriers, and pandemic impacts.
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