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Perspectives of Primary-Care Providers on Heart Failure in Long-Term Care Homes*

Published online by Cambridge University Press:  07 August 2014

George A. Heckman ,
Veronique M. Boscart ,
Robert S. McKelvie ,
Teresa D’Elia ,
Osman Osman ,
Sharon Kaasalainen ,
Mary Lou Kelley ,
Carrie McAiney ,
Paul Stolee  and
Patricia Strachan
George A. Heckman*
Affiliation:
Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo
Veronique M. Boscart
Affiliation:
Conestoga College
Robert S. McKelvie
Affiliation:
Population Health Research Institute, McMaster University
Teresa D’Elia
Affiliation:
Institute for Work & Health, Toronto
Osman Osman
Affiliation:
University of Waterloo
Sharon Kaasalainen
Affiliation:
Faculty of Health Sciences, McMaster University
Mary Lou Kelley
Affiliation:
School of Social Work, Lakehead University
Carrie McAiney
Affiliation:
Department of Psychiatry & Behavioural Neurosciences, McMaster University Seniors Mental Health Service, St. Joseph’s Healthcare Hamilton
Paul Stolee
Affiliation:
School of Public Health and Health Systems, University of Waterloo
Patricia Strachan
Affiliation:
Faculty of Health Sciences, McMaster University
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to:George A. Heckman, M.D.BMH 3734University of Waterloo200 University Ave. WestWaterloo, ON N2L 3G1(ggheckma@uwaterloo.ca)
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Abstract

Heart failure (HF) is common among long-term care (LTC) residents, and may account for 40 per cent of acute-care transfers. Canadian Cardiovascular Society HF guidelines endorse standard therapies; yet LTC residents are less likely to receive treatment. This qualitative study employed focus groups to explore perceptions, from 18 physicians and nurse practitioners in three Ontario homes, on HF care practices and challenges. For example, participants reported challenges with HF diagnostic skills and procedural knowledge. They also identified the need for interprofessional collaboration and role clarification to improve HF care and outcomes. To address these challenges, multimodal interventions and bedside teaching are required. Leadership was viewed as essential to improve HF care. Several concerns arose regarding knowledge gaps and clinical deficits among primary-care providers who manage heart failure in LTC residents. Multimodal, clinically focused educational and interprofessional solutions are needed to improve HF care in long-term care.

Résumé

L'insuffisance cardiaque (IC) est fréquente chez les résidents en soins de longue durée (SLD), et peut représenter 40 pour cent des transferts aux soins aigus. Des lignes directrices de l’IC de la Société canadienne de cardiologie approuvent les traitements standards, mais les résidents de SLD sont moins susceptibles de recevoir un traitement.* Cette étude qualitative a utilisé des groupes de discussion pour explorer les perceptions, de 18 médécins et infirmières praticiennes dans trois foyers de l’Ontario, des pratiques de soins de l’IC et les défis de SLD. Par exemple, les participants ont rapporté les défis concernant aptitudes diagnostiques et les connaissances procédurales de l’IC. Ils ont également identifié la nécessité de la collaboration interprofessionnelle et la clarification des rôles pour améliorer les soins et les résultats de l’IC. Pour résoudre ces problèmes, les interventions multi-modales et l'enseignement de chevet sont requis. Le leadership a été considéré comme essentielle pour améliorer les soins de l’IC. Plusieurs préoccupations ont surgi concernant les lacunes dans les connaissances et les déficits cliniques chez les fournisseurs de soins primaires qui traitent l'insuffisance cardiaque chez les résidents de SLD. Pour améliorer les soins de l'IC à long terme, des solutions éducatives et interprofessionnelles multi-modales et cliniquement ciblées sont nécessaires.

Keywords

agingbest-practice guidelinesheart failurelong term careolder adultsprimary carevieillissmentlignes directrices sur les pratiques exemplairesinsuffisance cardiaquesoins (de) longue duréeaînéssoins primaires
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 33 , Issue 3 , September 2014 , pp. 320 - 335
Copyright
Copyright © Canadian Association on Gerontology 2014 

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Footnotes

*

The authors acknowledge the nursing homes and participants in this study. The authors are grateful for the administrative assistance of Nisreen Murad and Christie Gennings. The authors also acknowledge the contributions to the project of Catherine Demers, Ian Newhouse, Erin Tjam, Mary-Lou van der Horst, Jill Marcella, and Alesha Gaudet.

References

Allen, L. A., Hernandez, A. F., Peterson, E. D., Curtis, L. H., Dai, D., Masoudi, F. A., et al. (2011). Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure. Circulation: Heart Failure, 4, 293–300.Google ScholarPubMed
American Medical Directors Association (AMDA). (2002). Heart Failure: Clinical Practice Guideline 2002.Google Scholar
Arnold, J. M. O., Liu, P., Demers, C., Dorian, P., Giannetti, N., Haddad, H., et al. (2006). Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management. Canadian Journal of Cardiology, 2, 23–45.CrossRefGoogle Scholar
Bharwani, A. M., Harris, G. C., & Southwick, F. S. (2012). Perspective: A business school view of medical interprofessional rounds: Transforming rounding groups into rounding teams. Academic Medicine, 87, 1768–1771.CrossRefGoogle ScholarPubMed
Bowman, C. E., Elford, J., Dovey, J., Campbell, S., & Barrowclough, H. (2001). Acute hospital admissions from nursing homes: Some may be avoidable. Postgraduate Medical Journal, 77, 40–42.CrossRefGoogle ScholarPubMed
Boxer, R. S., Dolansky, M. A., Frantz, M. A., Prosser, R., Hitch, J. A., & Piña, I. L. (2012). The Bridge Project: Improving heart failure care in skilled nursing facilities. Journal of the American Medical Directors Association, 13(1), 83.e1–83.e7.CrossRefGoogle Scholar
Canadian Institute for Health Information (CIHI). (2009). Patient pathways: Transfers from continuing care to acute care. Ottawa: Author.Google Scholar
Chaudhry, S. I., Wang, Y., Concato, J., Gill, T. M., & Krumholz, H. M. (2007). Patterns of weight change preceding hospitalization for heart failure. Circulation, 116, 1549–1554.CrossRefGoogle ScholarPubMed
Coburn, A. F., Keith, R. G., & Bolda, E. J. (2002). The impact of rural residence on multiple hospitalizations in nursing facility residents. The Gerontologist, 42, 661–666.CrossRefGoogle ScholarPubMed
Coleman, E. A. (2003). Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs. Journal of the American Geriatrics Society, 51, 549–555.CrossRefGoogle ScholarPubMed
Colón-Emeric, C. S., Lekan, D., Utley-Smith, Q., Ammarell, N., Bailey, D., Corazzini, K., et al. (2007). Barriers to and facilitators of clinical practice guideline use in nursing homes. Journal of the American Geriatrics Society, 55, 1404–1409.CrossRefGoogle ScholarPubMed
Conn, R. D., & O’Keefe, J. H. (2009). Cardiac physical diagnosis skills in the digital age: An important but increasingly neglected skill (from stethoscopes to microchips). American Journal of Cardiology, 104, 590–595.CrossRefGoogle ScholarPubMed
Corazzini, K. N., McConnell, E. S., Anderson, R. A., Reed, D., Champagne, M. T., Lekan, D., et al. (2010). The importance of organizational climate to training needs and outcomes in long-term care. Alzheimer’s Care Today, 11(2), 109–121.Google Scholar
Creswell, J. (2009). Research design: Qualitative, quantitative and mixed method approaches (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Daamen, M. A., Schols, J. M., Jaarsma, T., & Hamers, J. P. (2010). Prevalence of heart failure in nursing homes: A systematic literature review. Scandinavian Journal of Caring Science, 24, 202–208.CrossRefGoogle ScholarPubMed
Donald, F., & Martin-Misner, R. (2011). Understanding the individual, organizational, and system factors influencing the integration of the nurse practitioner role in long term care settings in Canada. Ryerson University. Retrieved 30 June 2014 fromhttp://www.ryerson.ca/apnltc/pdf/FinalReport.pdf.Google Scholar
Donald, F., Martin-Misener, R., Carter, N., Donald, E. E., Kaasalainen, S., Wickson-Griffiths, A., et al. (2013). A systematic review of the effectiveness of advanced practice nurses in long-term care. Journal of Advanced Nursing, 69(10), 2148–2161. doi: 10.1111/jan.12140.CrossRefGoogle ScholarPubMed
Finn, J. C., Flicker, L., Mackenzie, E., Jacobs, I. G., Fatovich, D. M., Drummond, S., et al. (2006). Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia. Medical Journal of Australia, 184, 432–435.CrossRefGoogle Scholar
Fonseca, C., Morais, H., Mota, T., Matias, F., Costa, C., Gouveia-Oliveira, A., et al. (2004). The diagnosis of heart failure in primary care: Value of symptoms and signs. European Journal of Heart Failure, 6, 795–800, 821–822.CrossRefGoogle ScholarPubMed
Glenny, C., Heckman, G., & McKelvie, R. (2012). Heart failure in older persons: Considerations for the primary care physician. Canadian Geriatrics Society Journal of CME, 1, 9–17.Google Scholar
Gordon, J. E. (2011). Updated survey of the geriatric content of Canadian undergraduate and postgraduate medical curricula. Canadian Geriatric Journal, 2, 34–39.CrossRefGoogle Scholar
Gray, L. C., Peel, N. M., Cost, A. P., Burkett, E., Dey, A. B., Jonsson, P. V., et al. (2013). Profiles of older patients in the emergency department: Findings from the interRAI multinational emergency department study. Annals of Emergency Medicine, 62(5), 467–474.Google ScholarPubMed
Gruneir, A., Bell, C. M., Bronskill, S. E., Schull, M., Anderson, G. M., & Rochon, P. A. (2010). Frequency and pattern of emergency department visits by long-term care residents – A population-based study. Journal of American Geriatrics Society, 58, 510–517.CrossRefGoogle ScholarPubMed
Hancock, H. C., Close, H., Mason, J. M., Murphy, J. J., Fuat, A., de Belder, M., et al. (2012). Feasibility of evidence-based diagnosis and management of heart failure in older people in care: A pilot randomized controlled trial. BMC Geriatrics, 12(70), 1–10.CrossRefGoogle Scholar
Heckman, G., & Boscart, V. (2013). Barriers to heart failure management in Ontario long term care homes. Podium presentation at the 4th Ontario Long Term Care Annual Research Day, Toronto, Ontario, February 13, 2013.Google Scholar
Hogan, D. B., Borrie, M., Basran, J. F. S., Chung, A. M., Jarrett, P. G., Morais, J. A., et al. (2012). Specialist physicians in geriatrics – Report of the Canadian geriatrics society physician resource work group. Canadian Geriatrics Journal, 15(3), 68–79.CrossRefGoogle ScholarPubMed
Hollander, M. J., & Price, M. J. (2008). Organizing healthcare delivery systems for persons with ongoing care needs and their families: A best practices framework. Healthcare Quarterly, 11(1), 44–54.CrossRefGoogle Scholar
Hutt, E., Elder, S. J., Fish, R., & Min, S. J. (2011). Regional variation in mortality and subsequent hospitalization of nursing home residents with heart failure. Journal of the American Medical Directors Association, 12, 595–601.CrossRefGoogle ScholarPubMed
Hutt, E., Frederickson, E., Ecord, M., & Kramer, A. M. (2003). Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Journal of the American Medical Directors Association, 4, 195–199.CrossRefGoogle ScholarPubMed
Jacobs, B. (2011). Reducing heart failure hospital readmissions from skilled nursing facilities. Professional Case Management, 16, 18–24.CrossRefGoogle ScholarPubMed
Johri, M., Beland, F., & Bergman, H. (2003). International experiments in integrated care for the elderly. International Journal of Geriatric Psychiatry, 18, 222–235.CrossRefGoogle ScholarPubMed
Jurgens, C. Y. (2006). Somatic awareness, uncertainty, and delay in care-seeking in acute heart failure. Research in Nursing & Health, 29, 74–86.CrossRefGoogle ScholarPubMed
Kaasalainen, S., Strachan, P., Heckman, G., D’Elia, T., McKelvie, R., McAiney, C., et al. (2013). Living and dying with heart failure in long term care. International Journal of Palliative Nursing, 10(8), 375–382.CrossRefGoogle Scholar
Katz, P. R., & Pfeil, L. A. (2013). Nursing home physicians and the credibility gap. Journal of the American Medical Directors Association, 14(2), 83–84.CrossRefGoogle ScholarPubMed
Kurasaki, K. (2000). Intercoder reliability for validating conclusions drawn from open-ended interview data. Field Methods, 12(3), 179–194.CrossRefGoogle Scholar
Laukkanen, A., Ikäheimo, M., & Luukinen, H. (2006). Practices of clinical examination of heart failure patients in primary health care. Central European Journal of Public Health, 14, 86–89.CrossRefGoogle ScholarPubMed
Marcella, J., Nadarajah, J., Kelley, M., Heckman, G., Kaasalainen, S., Strachan, P., et al. (2012). Understanding organizational context and heart failure management in long term care homes in Ontario, Canada. Health, 4, 725–734.CrossRefGoogle Scholar
Mavaddat, N., & Mant, J. (2010). Primary care research and clinical practice: Cardiovascular disease. Postgraduate Medical Journal, 86, 696–703.CrossRefGoogle ScholarPubMed
Maxwell, J. A. (2005). Qualitative research design: An interactive approach (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
McAiney, C. A., Stolee, P., Hillier, L. M., Harris, D., Hamilton, P., Kessler, L., et al. (2007). Evaluation of the sustained implementation of a mental health learning initiative in long-term care. International Psychogeriatrics, 19(5), 842–858.CrossRefGoogle ScholarPubMed
McGrail, K. M., McGregor, M. J., Cohen, M., Tate, R. B., & Ronald, L. A. (2007). For-profit versus not-for-profit delivery of long-term care. Canadian Medical Association Journal, 176, 57–58.CrossRefGoogle ScholarPubMed
McKelvie, R. S., Moe, G. W., Ezekowitz, J. E., Heckman, G. A., Costigan, J., Ducharme, S., et al. (2013). The 2012 Canadian cardiovascular society heart failure management guidelines update: Focus on acute and chronic heart failure. Canadian Journal of Cardiology, 29(2), 168–181.CrossRefGoogle Scholar
Montgomery, K. (2006). Clinical judgment and the interpretation of the case. In How doctors think: Clinical judgment and the practice of medicine. New York: Oxford University Press.Google Scholar
Morgan, D. (1997). Focus groups as qualitative research (2nd ed.). London: Sage.CrossRefGoogle Scholar
National Physician Survey. (2010). Retrieved 30 June 2014 fromhttp://nationalphysiciansurvey.ca/surveys/2010-survey/.Google Scholar
Newhouse, I. J., Heckman, G., Harrison, D., D’Elia, T., Kaasalainen, S., Strachan, P. H., et al. (2012). Barriers to the management of heart failure in Ontario long-term care homes: An interprofessional care perspective. Journal of Research in Interprofessional Practice and Education, 2(3), 278–295.CrossRefGoogle Scholar
Olofsson, M., Edebro, D., & Boman, K. (2007). Are elderly patients with suspected HF misdiagnosed? Cardiology, 107, 226–232.CrossRefGoogle ScholarPubMed
Ouslander, J. G., Diaz, S., Hain, D., & Tappen, R. (2011). Frequency and diagnoses associated with 7- and 30-day readmission of skilled nursing facility patients to a nonteaching community hospital. Journal of the American Medical Directors Association, 12(3), 195–203.CrossRefGoogle ScholarPubMed
Parsons, H. M. (1974). What happened at Hawthorne? Science, 183, 922–932.CrossRefGoogle ScholarPubMed
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Peixoto, A. J. (2001). Birth, death, and resurrection of the physical examination: Clinical and academic perspectives on bedside diagnosis. Yale Journal of Biology and Medicine, 74(4), 221–228.Google ScholarPubMed
Peters-Klimm, F., Natanzon, I., Muller-Tasch, T., Ludt, S., Nikdendei, C., Lossnitzer, N., et al. (2012). Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: A qualitative study. GMS Zeitschrift fur Medizinische Ausbildung, 29(3), 10–17.Google ScholarPubMed
Remme, W. J., McMurray, J. J., Hobbs, F. D., Cohen-Solal, A., Lopez-Sendon, J., Boccanelli, A., et al. (2008). SHAPE Study Group. Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians. European Heart Journal, 29(14), 1739–1752.CrossRefGoogle Scholar
Rizza, P., Bianco, A., Pavia, M., & Angelillo, I. F. (2007). Preventable hospitalization and access to primary health care in an area of Southern Italy. BMC Health Services Research, 7, 134.CrossRefGoogle Scholar
Rutten, F. H., Moons, K. G. M., Cramer, M.-J. M., Grobbee, D. E., Zuithoff, N. P. A., Lammers, J.-W., et al. (2005). Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: Cross sectional diagnostic study. British Medical Journal, 331, 1379–1385.CrossRefGoogle ScholarPubMed
San Martín-Rodríguez, L., Beaulieu, M. D., D’Amour, D., & Ferrada-Videla, M. (2005). The determinants of successful collaboration: A review of theoretical and empirical studies. Journal of Interprofessional Care, 19(Suppl. 1), 132–147.CrossRefGoogle Scholar
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Stolee, P., Esbaugh, J., Aylward, S., Cathers, T., Harvey, D. P., Hillier, L. M., et al. (2005). Factors associated with the effectiveness of continuing education in long-term care. Gerontologist, 45(3), 399–405.CrossRefGoogle ScholarPubMed
Stolee, P., & Hillier, L. M. (2006). The Ontario nurse practitioner project in long-term care facilities pilot project. Aestima Research, London, Ontario, 2002. Retrieved 30 June 2014 fromhttp://www.health.gov.on.ca/en/common/ministry/publications/reports/nurseprac02/np_report_022302.pdf.Google Scholar
Stolee, P., Hillier, L. M., Esbaugh, J., Griffiths, N., & Borrie, M. J. (2006). Examining the nurse practitioner role in long-term care: Evaluation of a pilot project in Canada. Journal of Gerontological Nursing, 32, 28–36.Google ScholarPubMed
Stolee, P., McAiney, C. A., Hillier, L. M., Harris, D., Hamilton, P., Kessler, L., et al. (2009). Sustained transfer of knowledge to practice in long-term care: Facilitators and barriers of a mental health learning initiative. Gerontology Geriatrics Education, 30(1), 1–20.CrossRefGoogle ScholarPubMed
Sullivan, M. P., Parenteau, P., Dolansky, D., Leon, S., & Clair, Le, , J. K. (2007). Shared geriatric mental health care in a rural community. Canadian Journal of Rural Medicine, 12(1), 22–29.Google Scholar
Suter, E., Oelke, N. D., Adair, C. E., & Armitage, G. D. (2009). Ten key principles for successful health systems integration. Healthcare Quarterly, 13(Special Issues), 16–23.CrossRefGoogle ScholarPubMed
Vedel, I., Monette, M., Beland, F., Monette, J., & Bergman, H. (2011). Ten years of integrated care: Backwards and forwards. The case of the province of Québec, Canada. International Journal of Integrated Care, 11(7), 1–11.CrossRefGoogle ScholarPubMed
Weech-Maldonado, R., Meret-Hanke, L., Neff, M. C., & Mor, V. (2004). Nurse staffing patterns and quality of care in nursing homes. Health Care Management Review, 29, 107–116.CrossRefGoogle ScholarPubMed
Williams, A. P., Lum, J. M., Deber, R., Montgomery, R., Kuluski, K., Peckham, A., et al. (2009). Aging at home: Integrating community-based care for older persons. Healthcare Papers, 10(1), 8–21.CrossRefGoogle ScholarPubMed