Investment in tools and resources in primary care

With more and more people suffering from chronic conditions such as heart failure, the main challenge for all health care systems across Europe is to provide patients with high quality care and support outside of the hospital. But most health care systems are poorly equipped to do this.

Cristian Silviu Busoi, MEP

Overview

Inadequate follow-up and long-term care in primary care is one of the key reasons why patients with heart failure often end up being admitted to hospital. GPs are usually the first point of contact for patients with heart failure. However, they often do not have the time or resources to monitor their patients, and nurses with specific training in heart failure are usually not available to fulfil this role.

Innovative tools that encourage self-care – for example patient self-monitoring tools – may also help keep heart failure patients out of hospital. However, in most countries these tools are often stuck in ‘pilot’ mode because of logistic or institutional barriers and are not implemented on a broad scale.

If we are to improve outcomes for people living with heart failure, we urgently need careful workforce planning and better use of tools that encourage self-management in primary care. Each healthcare setting needs to explore the feasibility of different approaches to suit their particular context.

Economic case

  • Personalised follow up in the community has been shown to contribute to reducing the number of unplanned hospital admissions for patients with heart failure, along with appropriate patient education.*
  • Specialist care and lifestyle advice from a heart failure specialist nurse, along with input from a cardiologist and support from a GP, can reduce hospital admissions, improve adherence to treatment and enhance patient’s quality of life.*
  • The use of patient monitoring tools, such as electronic devices to monitor vital signs, can reduce hospitalisations for patients living with heart failure by 21%, all-cause mortality by 20%* and save healthcare costs in the long run.*

The Patient's view

“I can’t believe not everyone has a heart failure nurse – I would be lost without mine.”
Julie, a woman living with heart failure

“A lot of patients out there want to try to self-manage, if they are given the tools, the opportunity and if they can work with other patient groups and professionals. So have a look at your own health systems, the multidisciplinary teams, the tools and the level of education that are on offer for patients, or the engagement methods that are used to support them.”
Nick, a man living with heart failure

Priorities for action:

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  • Paul S. Hospital discharge education for patients with heart failure: what really works and what is the evidence? Critical care nurse 2008;28(2):66-82.

    Mocillo C, Valderas J, Aguado O, et al. Evaluation of a Home-Based Intervention in Heart Failure Patients. Results of a Randomized Study. Revista Española de Cardiología 2005;58(6):18-25.

    Roig E, Pérez-Villa F, Cuppoletti A, et al. Specialized Care Program for End-Stage Heart Failure Patients. Initial Experience in a Heart Failure Unit. Revista Española de Cardiología 2006;59(2):109-16.

    Anderson C, Deepak BV, Amoateng-Adjepong Y, et al. Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure. Congestive heart failure (Greenwich, Conn) 2005;11(6):315-21.

  • Jaarsma T, Beattie J, Ryder M, et al. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure 2009;11:433-43.

  • Adler ED, Goldfinger JZ, Kalman J, et al. Palliative Care in the Treatment of Advanced Heart Failure. Circulation 2009;120(25):2597-606.

  • Boyd K, Murray S, Kendall M, et al. Living with advanced heart failure: a prospective, community based study of patients and their carers. The European Journal of Heart Failure 2004(585-591).

    Health Service Executive, Irish Hopice Foundation. Palliative Care for All - Integrating Palliative Care into Disease Management Frameworks, 2008.