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dc.contributor.authorGrace, Sherry
dc.contributor.authorRoss, Heather
dc.contributor.authorPakosh, Maureen
dc.contributor.authorLee, Douglas
dc.contributor.authorHarkness, Karen
dc.contributor.authorVirani, Sean
dc.contributor.authorMcDonald, Michael
dc.contributor.authorAbrahamyan, Lusine
dc.contributor.authorDobrow, Mark
dc.contributor.authorFrankfurter, Claudia
dc.contributor.authorFowokan, Adeleke
dc.date.accessioned2021-05-10T19:17:45Z
dc.date.available2021-05-10T19:17:45Z
dc.date.issued2020-10
dc.identifier.citationJournal of Evaluation in Clinical Practice. (2020); 1– 16. International Journal of Health Policy and Health Services Research. Referral and access to heart function clinics: A realist review.en_US
dc.identifier.issn1365-2753
dc.identifier.urihttps://doi.org/10.1111/jep.13489en_US
dc.identifier.urihttp://hdl.handle.net/10315/38316
dc.description.abstractRationale, aim, and objectives Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. Methods Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full‐texts. Relevant data from included articles were used to refine the program theory. Results A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). Conclusion Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub‐optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.en_US
dc.language.isoenen_US
dc.publisherWileyen_US
dc.rightsThis is the peer reviewed version of the following article: Journal of Evaluation in Clinical Practice. (2020); 1– 16. International Journal of Health Policy and Health Services Research. Referral and access to heart function clinics: A realist review, which has been published in final form at https://doi.org/10.1111/jep.13489. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.en_US
dc.subjectsex differencesen_US
dc.subjectrealist reviewen_US
dc.subjectnursingen_US
dc.subjectheart failureen_US
dc.subjecthealth serviceen_US
dc.subjectdisease managementen_US
dc.titleReferral and Access to Heart Function Clinics: A Realist Reviewen_US
dc.title.alternativeRunning Title: Heart Function Clinic Access -Realist Reviewen_US
dc.typeArticleen_US
dc.rights.journalhttps://onlinelibrary.wiley.com/journal/13652753en_US
dc.rights.publisherhttps://onlinelibrary.wiley.com/en_US
dc.rights.articlehttps://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.13489en_US


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