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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.

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