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Case management for patients with chronic systolic heart failure in primary care: the HICMan exploratory randomised

Frank Peters-Klimm1, Stephen Campbell, Katja Hermann

  • 1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. frank.peters@med.uni-heidelberg.de

Trials
|May 19, 2010
PubMed

Insights

Case management for chronic heart failure (CHF) by doctors assistants improved self-care and quality of care but did not significantly impact health outcomes or quality of life in this study.

Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Health Services Research

Background:

  • Chronic heart failure (CHF) presents a significant burden, necessitating effective interventions.
  • Case management is a promising approach for improving patient outcomes in CHF, particularly in primary care settings.
  • A new CHF case management model involving doctors' assistants (DAs) and general practitioners (GPs) was evaluated.

Purpose of the Study:

  • To explore the effectiveness of a novel CHF case management model.
  • To assess the impact of DA-led case management supported by GPs on patient outcomes.
  • To evaluate the feasibility of this intervention in primary care practices.

Main Methods:

  • A patient-randomised controlled trial (Phase II) involving 31 DAs and GPs across 29 practices.
  • Patients with CHF received either 12 months of case management (telephone monitoring, home visits) or usual care.
  • Data collected included clinical outcomes, healthcare utilization, and patient-reported quality of life, self-care, and quality of care.

Main Results:

  • Baseline adherence to pharmacotherapy and patient self-care were already high.
  • Case management (CM) showed significant improvements in CHF self-care (EHFScBS scores) and quality of care (PACIC-5A scores).
  • No significant group differences were observed in quality of life (QoL) scores or hospital admission/mortality rates.

Conclusions:

  • The case management model demonstrated feasibility and improved key intermediate outcomes like self-care and quality of care.
  • In a population with high baseline adherence, the intervention did not lead to significant improvements in overall health outcomes or QoL.
  • The study provides evidence for the potential of DA-led case management in CHF care within primary care.
Abstract

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