Variations in family physicians’ and cardiologists’ care for patients with heart failure☆,☆☆
Section snippets
Study group and sample size
To compare the self-reported practices of family physicians and cardiologists, it was estimated that responses from 250 physicians in each group were required to achieve an 80% power (β error .20) to detect 10% absolute intergroup differences with an α error of .05. Assuming a minimal response rate of 40% and an undeliverable rate of 20%, surveys were mailed to 500 physicians from each group. The sample was randomly selected from the American Medical Association’s physician master file.
Physician survey
This
Response rate to survey
Of 1000 surveys mailed, 3% were sent to physicians who were deceased or retired and 7% were undeliverable at the addresses provided. Seven percent of the physicians returned the survey but indicated their refusal to respond. Of the remaining 825 physicians, 401 returned the questionnaire. This figure includes 224 family physicians and 177 cardiologists. Forty-two family physicians and 14 cardiologists were not included in the final analysis because of predetermined criteria of not seeing at
Discussion
Previous studies have shown that quality of care for patients with CHF in community practice is suboptimal for both in-patients13, 14 and out-patients.15, 23 Better understanding of the reasons why physicians may not use recommended diagnostic or therapeutic modalities should help guide future quality improvement efforts. The results of this survey indicate several factors that may influence quality of care for family physicians who care for patients with CHF.
First, our results suggest that
Acknowledgements
We thank the physicians who completed the survey, the Kerr L. White Institute staff who helped in the administration of this survey, and Lindsay Gressard for assistance in the preparation of the manuscript.
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Cited by (53)
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
2009, Journal of the American College of CardiologyCitation Excerpt :Insufficient evidence exists to allow for recommendations about the most appropriate roles for generalist physicians and cardiologists in the care of patients with HF. Several studies indicate that primary care physicians as a group have less knowledge about HF and adhere to guidelines less closely than cardiologists (805–807). Some studies have noted better patient outcomes in patients cared for by cardiologists than in those cared for by generalist physicians (808,809), whereas another study reported that cardiologists deliver more costly care that is accompanied by a trend toward improved survival (810).
Treating the right patient at the right time: Access to specialist consultation and noninvasive testing
2006, Canadian Journal of CardiologyACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to update the 2001 guidelines for the evaluation and management of heart failure)
2005, Journal of the American College of CardiologyTelecardiology for patients with chronic heart failure: The 'SHL' experience in Israel
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