Healthcare services for heart failure patients underutilised: Research

General practice care options for heart failure (HF) patients are not being fully utilised, new research has found, despite people living with the condition visiting their GP on average 14 times per year.
 
Published in the Australian Journal of General Practice (AJGP), the paper forms part of the ‘Study of Heart failure in the Australian Primary carE setting (SHAPE)’ – the first long-term research into the management of heart failure in Australia.
 
The study includes the records of 1.93 million adult Australians from 43 general practices. More than 20,219 patients were identified as having HF, and their records were subsequently examined to describe the frequency of visits and use of MBS items.
 
The analysis revealed that only 59.5% had a General Practice Management Plan (GPMP) in place, while less than half (46.8%) had been referred to a cardiologist within one month of diagnosis. Of those with a GPMP, only 2.9% had had it reviewed at least annually.
 
According to the paper’s authors, the low use of care planning and reviews presents an ‘opportunity’ for GPs to improve care for HF patients.
 
‘Holistic care planning and team reviews are frequently not being implemented, with large gaps in both the uptake and renewal of care plans,’ it states.
 
‘This presents an opportunity for general practice in coordinating care and improving adherence to guideline-based therapy for people with HF.’
 
Professor Ralph Audehm, GP and SHAPE lead author, told newsGP there could be ‘many reasons’ for the lack of referrals, but highlighted access as a major contributor – especially for those in the public system.
 
‘There is also uncertainty [surrounding] who is the lead in managing the patient, what role the GP has, and uncertainty over what needs to be done [due to] rapid changes in treatments available for HF,’ he said.
 
However, Professor Audehm said as patients with HF tend to visit their GP frequently, there are often ‘many opportunities’ for GPs to intervene and improve their outcomes.
 
‘Planned reviews, which improve outcomes, would improve outcomes and improve the viability for general practice. Early intervention can make a huge difference and save lives,’ he said.
 
‘The message here is that shared care leads to the best outcomes.’
 
But while shared care is ideal, there are also barriers within Australia’s healthcare system.
 
‘Often time is an issue,’ Professor Audehm said. ‘[As is knowing] the roles of each of the teams, access to allied health, the role of practice nurses in planned care, and forgetting about how powerful home medication reviews can be in preventing issues.
 
‘A planned approach with pathways and guideline usage for patients of the practice – using a systematic approach rather than an approach of catching people when they turn up – is key.’
 
Slightly more than 20% of patients with definite and probable HF received practice nurse support, while the use of home medicine reviews was even more uncommon (5.4%).
 
In addition to the above results, the paper also found that only 37% of HF patients with anxiety and depression had a GP Mental Health Treatment Plan (GP-MHTP).
 
Co-existing HF with anxiety and depression is common, and made worse by the stress and worry of the condition, which can in turn worsen the overall health of the body and heart.
 
Professor Andrew Sindone, cardiologist, heart failure specialist and SHAPE study co-author, Sydney, believes the overall findings show Australia’s healthcare system is not being utilised to its full potential.
 
‘We have optimal care for the management of heart failure available in Australia, including Government-funded care plans with established processes which are proven to improve outcomes,’ he said.
 
‘I strongly encourage GPs and specialists to plan more collaborative and multi-disciplinary team care to ensure the best possible outcomes.’
 
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cardiology collaborative care General Practice Management Plans heart failure