Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Substitution of care for chronic heart failure from the hospital to the general practice: patients’ perspectives

Authors: J. A. Wildeboer, A. R. T. van de Ven, D. de Boer

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Shifting care from the secondary to the primary system may present an opportunity to ensure that the increasing number of patients with chronic heart failure (CHF) receive high-quality care while containing costs. However, shifting from secondary to primary care might seem radical to patients. A qualitative insight into patients’ issues, preferences, expectations and needs may help arrange a smooth transition from secondary to primary care for CHF patients. The aim of this exploratory study is therefore to gain insights into the way CHF patients in secondary care perceive the possibility of substitution of CHF care from secondary to primary care.

Methods

In total, fifteen semi-structured interviews were conducted with CHF patients. Topics discussed during the interviews were the advantages and disadvantages, attitudes of patients, preferences regarding the substitution and trust in the GP and cardiologist. A thematic analysis was performed.

Results

The minority of the patients welcomed the idea of substitution. Against that, the majority of the patients had various concerns. This attitude was mainly influenced by two main themes, confidence and security and accessibility. Most patients had more confidence in secondary than in primary care because of the greater level of knowledge and more possibilities for examination in secondary care and because of good relationships and positive previous experiences in secondary care. Patients also indicated that the general practice is geographically more easily accessible than the hospital.

Conclusion

Patients had various concerns regarding the substitution of care for chronic heart failure. Addressing these concerns by informing them appropriately may contribute to a smooth and patient-friendly substitution from secondary to primary care. The fears and needs of patients could also be taken into account by policymakers when optimising the way substitution is organised, or when substitution is introduced.
Appendix
Available only for authorised users
Literature
1.
Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nature reviews. Cardiology. 2011;8(1):30–41.PubMed
2.
3.
Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121(7):e46–e215.CrossRefPubMed
4.
Ho KK, Pinsky JL, Kannel WB, Levy D, Pitt B. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993;22(4s1):A6–A13.CrossRef
5.
6.
Berry C, Murdoch DR, McMurray JJ. Economics of chronic heart failure. Eur J Heart Fail. 2001;3(3):283–91.CrossRefPubMed
7.
Braunschweig F, Cowie MR, Auricchio A. What are the costs of heart failure? Europace. 2011;13(suppl 2):ii13–i7.PubMed
8.
Drewes H, Boom J, Graafmans W, Struijs J, Baan C. Effectiviteit van disease management. Een overzicht van de (internationale) literatuur. RIVM rapport. 2008;260131001:2-39.
9.
CEv D, Korevaar J, JDd J, Koopmans B, Mv D, DHd B. Kennisvraag: ruimte voor substitutie? Verschuiving van de tweedelijns- naar eerstelijnszorg. NIVEL overzichtsstudies. 2013;
10.
van Rooy Y, Kuipers E, Veldman D, Dekker J, Daniëls M, Rouvoet A, et al. Addendum 2018 onderhandelaarsakkoord medisch-specialistische zorg 2014 t/m 2017. The Hague: Ministry of Health, Welfare and Sport; 2017.
11.
DJv V, Jaarsma T, Rutten FH, Jaarsma P, EK-vd P, Hulzebos HJ, et al. Zorg rondom hartfalen. Houten, the Netherlands: Bohn Stafleu van Loghum; 2015.
12.
13.
van Bodegom-Vos L, De Jong JD, Spreeuwenberg P, Curfs EC, Groenewegen PP. Are patients' preferences for shifting services from medical specialists to general practitioners related to the type of medical intervention? Qual Prim Care. 2013;21(2):81–95.PubMed
14.
World Health Organisation. Quality of care: a process for making strategic choices in health systems. Geneva: World Health Organisation. 2006.
15.
Sixma HJ, Kerssens JJ, Campen CV, Peters L. Quality of care from the patients' perspective: from theoretical concept to a new measuring instrument. Health Expect. 1998;1(2):82–95.CrossRefPubMedPubMedCentral
16.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006;18(1):59–82.CrossRef
17.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
18.
Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1(3):385–405.CrossRef
19.
Rutten PE. Hoe vaak komt hartfalen voor en hoeveel mensen sterven eraan? Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. 2014;Bilthoven: RIVM. (Retrieved from https://​www.​volksgezondheide​nzorg.​info/​onderwerp/​hartfalen. Nationaal Kompas Volksgezondheid\Gezondheidstoestand\Ziekten en aandoeningen\Hartvaatstelsel\Hartfalen,). Accessed 20 Dec 2017.
20.
Engelfriet P, Hoogenveen R, Poos M, Blokstra A, van Baal P, Verschuren W. Hartfalen: epidemiologie, risicofactoren en toekomst. RIVM rapport. 2012;260401006:3-122.
21.
Hoeymans N, Verheij RA, Schellevis FC, Baan CA. Multimorbiditeit en comorbiditieit in de Nederlandse bevolking-gegevens van huisartsenpraktijk. Ned Tijdschr Geneeskd. 2011;155:A3193.PubMed
22.
Dolgin M, Fox AC, Gorlin R, Levin RI. Criteria Committee, Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. New York Heart Association. 1994;Lippincott Williams and Wilkins.
23.
24.
25.
Tarrant C, Stokes T, Baker R. Factors associated with patients' trust in their general practitioner: a cross-sectional survey. Br J Gen Pract. 2003;53(495):798–800.PubMedPubMedCentral
26.
27.
Thom DH. Physician behaviors that predict patient trust. J Fam Pract. 2001;50(4):323–8.PubMed
28.
Thom DH, Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997;44(2):169–77.PubMed
29.
Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff. 2004;23(4):124–32.CrossRef
30.
Collier D, Mahoney J. Insights and pitfalls: selection bias in qualitative research. World Politics. 1996;49(01):56–91.CrossRef
31.
Bonds DE, Camacho F, Bell RA, Duren-Winfield VT, Anderson RT, Goff DC. The association of patient trust and self-care among patients with diabetes mellitus. BMC Fam Pract. 2004;5(1):1–7.CrossRef
32.
Evans AM, Dillon KD, Goldin G, Krueger JI. Trust and self-control. Judgm Decis Mak. 2011;6(7):697.
Metadata
Title
Substitution of care for chronic heart failure from the hospital to the general practice: patients’ perspectives
Authors
J. A. Wildeboer
A. R. T. van de Ven
D. de Boer
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-017-0688-z

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue

Research article

Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data

Research article

Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project

Research article

Patient satisfaction with primary healthcare services: are there any links with patients’ symptoms of anxiety and depression?

Research article

How general practitioners understand and handle medically unexplained symptoms: a focus group study

Research article

Impact of an integrated care program on glycemic control and cardiovascular risk factors in patients with type 2 diabetes in Saudi Arabia: an interventional parallel-group controlled study

Research article

How should we implement collaborative care for older people with depression? A qualitative study using normalisation process theory within the CASPER plus trial