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AuthorMamataz, Taslima
AuthorFowokan, Adeleke
AuthorHajaj, Ahmad Mohammad
AuthorAsghar, Areeba
AuthorAbrahamyan, Lusine
AuthorMcDonald, Michael
AuthorHarkness, Karen
AuthorGrace, Sherry L.
Available date2023-10-24T08:17:14Z
Publication Date2023
Publication NameCJC Open
ResourceScopus
ISSN2589790X
URIhttp://dx.doi.org/10.1016/j.cjco.2023.03.002
URIhttp://hdl.handle.net/10576/48812
AbstractBackground: Though heart failure patients benefit from multidisciplinary care in heart function clinics (HFCs), utilization is suboptimal and inequitable. This study investigated factors influencing referral and patient access to HFCs from multiple stakeholders' perspectives, namely policy-makers (PM), providers at HFCs and patients. Methods: In this qualitative study, semi-structured interviews with a purposive sample of Ontario stakeholders were conducted between February-June 2020 and July-December 2022 (paused due to pandemic) via Teams. Interview transcripts were concurrently analyzed using systematic text condensation with Nvivo. Two authors coded individually, with disagreements discussed with senior author. Results: Interviews with 7 HFCs (6 physicians, 1 nurse), 6 PM and 4 patients were completed before saturation; 5 themes emerged. First, with regard to health system organization, stakeholders reported gaps related to continuity of care, limited capacity and insufficient funding. Second, with regard to referral appropriateness and timeliness, sub-themes related to unclear referral criteria, varying clinic scope, and delays in triage, testing and time-to-visit. The third theme related to clinic characteristics, raised issues of varying clinic services and composition of healthcare professions/expertise. The fourth theme regarding patient factors related to comorbidity/frailty, socioeconomic status, barriers due to location (parking, traffic) and affinity to specific providers. The final theme related to the COVID-19 pandemic concerned increased referral volumes, loss to follow-up care, transition to online delivery modalities and patient refusal of in-person visits. Many facilitators to improve HFC referral and access were raised. Conclusions: Resources must be provided, and stakeholders brought together to standardize and integrate the HF care continuum.
SponsorThe authors are grateful to other members of the expert advisory panel who gave input on the ideas and the interview guide, including Drs. Doug Lee and Sean Virani, and the patient partners from the HeartLife Foundation. The study was approved by the institutional review boards of University Health Network (CAPCR ID#19-6171) and York University, Toronto. All participants provided written informed consent. This research was supported through a postdoctoral fellowship from the Ted Rogers Centre for Heart Research, University Health Network, Canada. No other specific grant was received from any funding agency in the public, commercial or not-for-profit sectors. The authors have no conflicts of interest to disclose.
Languageen
PublisherElsevier
SubjectHeart Failure
E-Health
Hospital Readmission
heart function clinics (HFCs)
TitleFactors Affecting Referral and Patient Access to Heart Function Clinics in Ontario: A Qualitative Study of Stakeholders
TypeArticle
Pagination421-428
Issue Number6
Volume Number5
dc.accessType Abstract Only


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