Joint outpatient clinics for the adult with congenital heart disease at the district general hospital: an alternative model of care.
Joint outpatient clinics for the adult with congenital heart disease at the district general hospital: an alternative model of care.
复制标题
地区综合医院针对先天性心脏病成人的联合门诊：另一种护理模式。
DOI：
10.1016/j.ijcard.2004.08.032
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发表时间：
2005
影响因子：
3.5
通讯作者：
M. Gatzoulis
中科院分区：
文献类型：
--
作者：
C. Shirodaria;D. Gwilt;M. Gatzoulis
先天性心脏病（CHD）影响英国约25万成年人。这些患者中的大多数将受益于专门的后续行动。然而，目前在英国和世界各地，专门的三级护理专业知识和设施在这个不断增长的心血管领域存在显着短缺。我们的目的是报告我们的经验，一个联合成人冠心病诊所在一个地区综合医院运行，定期输入从当地心脏病团队和来访的成人冠心病专家。在研究期间（1999年9月至2003年1月），共有148名年龄为33.6+/-14.1岁的患者在12家诊所接受了一次或多次治疗。诊断病例组合包括2.9%复杂、67.9%中度和29.2%轻度CHD病例。20%的患者前往对应的三级中心接受额外检查（主要是MRI），8%的患者接受干预（无手术死亡）。研究期间有1例死亡，总死亡率为0.2%/年。病人从第三级中心、当地心脏病和儿科诊所转诊到诊所，并有时间从产科和社区来源转诊。与第三级保健相比，不出勤率相对较低。这种模式的联合护理成人冠心病患者在一般地区医院定期现场专业投入似乎是有效的，并强调需要额外的资源分配，为这些患者提供最佳的护理。我们的数据可能有助于未来的CHD服务规划。
Congenital heart disease (CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/−14.1 years were seen once or more in 12 clinics over the study period (September 1999 to January 2003). Diagnostic case mix consisted of 2.9% complex, 67.9% moderate and 29.2% minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations (mostly MRI) and 8% for intervention (with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.