Abstract
BackgroundShifting care from the secondary to the primary system may present an opportunity to ensure that the increasing number of patients with chronic heart failure (CHF) receive high-quality care while containing costs. However, shifting from secondary to primary care might seem radical to patients. A qualitative insight into patients’ issues, preferences, expectations and needs may help arrange a smooth transition from secondary to primary care for CHF patients. The aim of this exploratory study is therefore to gain insights into the way CHF patients in secondary care perceive the possibility of substitution of CHF care from secondary to primary care.MethodsIn total, fifteen semi-structured interviews were conducted with CHF patients. Topics discussed during the interviews were the advantages and disadvantages, attitudes of patients, preferences regarding the substitution and trust in the GP and cardiologist. A thematic analysis was performed.ResultsThe minority of the patients welcomed the idea of substitution. Against that, the majority of the patients had various concerns. This attitude was mainly influenced by two main themes, confidence and security and accessibility. Most patients had more confidence in secondary than in primary care because of the greater level of knowledge and more possibilities for examination in secondary care and because of good relationships and positive previous experiences in secondary care. Patients also indicated that the general practice is geographically more easily accessible than the hospital.ConclusionPatients had various concerns regarding the substitution of care for chronic heart failure. Addressing these concerns by informing them appropriately may contribute to a smooth and patient-friendly substitution from secondary to primary care. The fears and needs of patients could also be taken into account by policymakers when optimising the way substitution is organised, or when substitution is introduced.
Highlights
Shifting care from the secondary to the primary system may present an opportunity to ensure that the increasing number of patients with chronic heart failure (CHF) receive high-quality care while containing costs
A qualitative insight into patients’ issues, preferences, expectations and needs relating to substitution of care will increase our understanding of how patients perceive this. Such understanding can help to optimise the way in which substitution is organised from the patients’ perspective, which can help improve the quality of care. The aim of this exploratory study is to gain insights into the way CHF patients in secondary care perceive the possibility of substitution of CHF care from secondary to primary care
Four patients (27%) did not have any other conditions in addition to CHF and eleven patients (73%) had one or more comorbidities such as diabetes, other heart and vascular diseases, renal insufficiency and pulmonary hypertension. These characteristics of the research population are representative of the entire population of CHF patients in the Netherlands [19,20,21]
Summary
Shifting care from the secondary to the primary system may present an opportunity to ensure that the increasing number of patients with chronic heart failure (CHF) receive high-quality care while containing costs. A qualitative insight into patients’ issues, preferences, expectations and needs may help arrange a smooth transition from secondary to primary care for CHF patients. The aim of this exploratory study is to gain insights into the way CHF patients in secondary care perceive the possibility of substitution of CHF care from secondary to primary care. The prevalence of chronic heart failure (CHF) is 23 million [3]. CHF comprises 1–2% of all healthcare costs. The majority of these costs are for frequent, longlasting and repeated hospitalisations [7]
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