Community-led treatment for heart failure
Cardiology The Heart Failure Virtual Consult; A novel way of using technology to deliever care into the community.
There are over 90,000 people in Ireland are living with heart failure and the estimated cost of heart failure is €660 million. Many challenges remain in the management of heart failure, with a changing profile of patients who are older and have multiple comorbidities and a high rate of hospital admissions. Use of modern communication systems has the potential to revolutionise heart failure care.
Heart failure, with the correct supports can largely be managed in the community. For GPs, the heart failure virtual consult (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 HFVC provides not only online, real time specific case discussion but also a dissemination of practical tips in heart failure care between GP and specialists. This offers an alternative to standard clinic assessment, and can provide the GP with all the information required, reducing need for onward referral and, therefore, can reduce unnecessary travel for the patient and their family – a meaningful bonus given the age and frailty of many patients with heart failure.
Easier access for patients and GPs
By managing heart failure in the community, the HFVC removes a step in the traditional care pathway facilitating interaction between the specialist/GP in a cost effiecient manner. Moreover, the HFVC reduces the need for out-patient department referrals, freeing up hospital out-patient slots for those in need of standard clinics resulting in shorter waiting times and speedier reviews.
To date, 150 GPs have signed up across the East Coast, Midlands and the 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 were also happy to have their conditions discussed with experts and groups of GPs and relieved not to have to travel to the hospital.
Over the initial 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 HFVC service. The travel distance saved for patients referred to this service was 10,552km. Usability and improvements in self reported efficacy were high for the GPs involved.
eHealth is the future
We 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 based 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 this type of webconferencing is easily transferable to other disease areas nationally.
The Heartbeat Trust has been at the forefront of the Heart Failure Virtual Clinics
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 Paddy Barrett, 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 St Michaels Hospital, having recently expanded into the Carlow Kilkenny region through support from the HSE.