Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model
Abstract
:1. Introduction
2. Method
2.1. Study Setting, Participants, and Design
2.1.1. Inclusion Criteria
2.1.2. Exclusion Criteria
2.1.3. Quantitative and Qualitative Data Stream
A. GP Office Level
B. Patient Level
Qualitative Interviews
3. Analysis
4. Results
4.1. Overall Experiences from the General Practitioners
“And the patients are very, very confident in what we can offer them. They can be evaluated at home” “The patients say it has been easier. They would much rather come here; they think it’s easier because they are comfortable here. They know where to sit in the waiting room and they have an appointment with their general practitioner”(GP).
“And then, there are those who never come to the hospital, no matter how sick they are. We can ask them to come here in the surroundings they know and feel safe. But if they must go to the hospital, they will never show up. There are also citizens who are cognitively handicapped and are so poorly functioning that they just can’t; they cannot find their way around, they cannot get in there, they do not know how, it is quite simply not an opportunity for them to visit the outpatient’s clinical the hospital”(GP).
4.2. The General Practitioners and Nurses Experience a High Level of Professionalism from the Cardiologist
“The collaboration with the cardiologist is safe and satisfactory. Everybody agrees”(Nurse).
4.3. The Technique Is User Friendly and Easy to Handle for Both Health Practitioners and Patients
“I think we’ve got a single or two files where the recording has not been there. The Holter has been disconnected. Typically, they wear it for more than a day, so you are able to see some of the files, nevertheless”(Nurse).
“I think there have been a few individual episodes where the Holter has been malfunctioning. But then the patient is wired again. So, there are very few technical problems”(Nurse).
4.4. Benefits of the C3 Holter Monitoring
“Normally, the patient should be referred to the hospital, when the patient should have Holter-monitoring. We have had direct access to a Holter. Also, there is a quick communication route to get permission. You save an incredible amount of health professionals’ time. In reality, I think it’s a huge financial saving in reality”(GP).
“I think Holter-monitoring belongs excellently out here in the primary sector, as long as we are able to get professional supervision with a cardiologist”(GP).
5. Discussion
5.1. Main Findings
5.2. Interpretation of Findings and Relation to Other Studies
5.3. Strengths and Limitations
5.4. Implications for Practice and Future Research
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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1 | Need for help with transportation to the hospital clinic |
2 | Need for help with personal hygiene |
3 | Walking impairment (reduced ability to walk—estimated to take more than 5 s for the patient to walk 5 m) |
4 | Unintentional weight loss within the past year |
5 | Cognitive difficulties (dementia, memory problems, aphasia, etc.) |
6 | Social problems due to alcohol abuse or other abuse, ethnic background, language, etc. |
Categories | Subcategories |
---|---|
Overall experiences of the general practitioners | Collaboration between general practitioner and cardiologist |
Implantation of the C3 | |
Staff training | |
Cardio-Share model | |
The general practitioners experience a high level of professionalism from the cardiologist | Equipment |
Professionalism | |
Confidence in the recordings | |
Preferable to use instead of the hospital | |
The technique is user friendly and easy to handle for both health practitioners and patients | Use of the equipment (C3) |
Use of software | |
Patient guidance Technical errors | |
Handling problems with C3 | |
Use of the equipment Introduction and guidance Preparation software Upload software | |
Benefits of the C3 Holter monitoring | Thoughts on quality |
Opportunities for improvement Benefits of working with a cardiologist |
GP * | Geriatrics | |
---|---|---|
N | 34 | 63 |
Age (years, range) | 73 (65–90) | 83 (55–98) |
Proportion age > 75 years (%) | 47 | 77 |
Gender (% females) | 59 | 53 |
Number of frailty criteria (mean, range) | 2 (1–4) | 3 (2–5) |
Proportion of psychiatric frailty component (%) | 33.3% | 35.3% |
CHADS–Vasc (mean, range) | 3 (1–5) | |
Heart failure (N, %) | 22 (65) | |
Hypertension (N, %) | 22 (65) | |
Age 65–74 years (N, %) | 15 (44) | |
Age > 74 years (N, %) | 19 (56) | |
Stroke (N, %) | 3 (9) | |
Vascular disease (N, %) | 6 (18) |
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Ladegaard, C.T.; Bamberg, C.; Aalling, M.; Jensen, D.M.; Kamstrup-Larsen, N.; Madsen, C.V.; Kamil, S.; Gudbergsen, H.; Saxild, T.; Schiøtz, M.L.; et al. Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model. Int. J. Environ. Res. Public Health 2022, 19, 7383. https://doi.org/10.3390/ijerph19127383
Ladegaard CT, Bamberg C, Aalling M, Jensen DM, Kamstrup-Larsen N, Madsen CV, Kamil S, Gudbergsen H, Saxild T, Schiøtz ML, et al. Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model. International Journal of Environmental Research and Public Health. 2022; 19(12):7383. https://doi.org/10.3390/ijerph19127383
Chicago/Turabian StyleLadegaard, Caroline Thorup, Carsten Bamberg, Mathias Aalling, Dorthea Marie Jensen, Nina Kamstrup-Larsen, Christoffer Valdorff Madsen, Sadaf Kamil, Henrik Gudbergsen, Thomas Saxild, Michaela Louise Schiøtz, and et al. 2022. "Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model" International Journal of Environmental Research and Public Health 19, no. 12: 7383. https://doi.org/10.3390/ijerph19127383
APA StyleLadegaard, C. T., Bamberg, C., Aalling, M., Jensen, D. M., Kamstrup-Larsen, N., Madsen, C. V., Kamil, S., Gudbergsen, H., Saxild, T., Schiøtz, M. L., Grew, J., Castillo, L. S., Frølich, A., & Domínguez, H. (2022). Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model. International Journal of Environmental Research and Public Health, 19(12), 7383. https://doi.org/10.3390/ijerph19127383