Multi-Method Study On Referral And Access To Heart Function Clinics

Patients with heart failure (HF) experience significant benefits from receiving comprehensive outpatient care in specialized heart failure clinics (HF clinics). These clinics have demonstrated their effectiveness in reducing frequent HF-related hospital readmissions while maintaining cost-efficiency. Unfortunately, despite established guidelines recommending the referral of HF patients to these clinics, there exists a notable discrepancy in both access and utilization of this specialized care, creating issues of low and inequitable service utilization. The underlying reasons are largely unknown and under-researched. Therefore, this doctoral dissertation aimed to advance a scholarly understanding of factors influencing the referral decisions and access to HF clinics through a multi-method study. For this purpose, three inter-linked research studies were undertaken. Firstly, qualitative interviews were conducted with key stakeholders in HF care, including policymakers, clinic providers, and patients. This initial phase established a foundational understanding of the barriers preventing optimal access to HF clinic services. Secondly, recognizing that referring providers play a pivotal role in determining patient access to HF clinics, a mixed-method design was employed, using a sequential exploratory approach to delve into their perspectives on the challenges associated with referring patients to HF clinics. Finally, a cross-sectional survey approach was adopted to compare clinic perceptions of ideal referral criteria with those of referring providers. By identifying areas of agreement between both parties, strategies for consistent application were proposed. This dissertation contributes valuable insights for HF clinics and the broader HF community. The knowledge generated has the potential, when translated into practice, to facilitate appropriate patient access to essential HF services. The findings offer guidance to policymakers, healthcare providers, and HF patients, aiming to optimize the utilization of HF clinic services, enhance the quality of care provided, and improve overall patient outcomes.