Abstract
Introduction: We evaluated an innovative service – HeartConnect - that aims to improve timely access to specialist cardiology services, to smooth patient journeys and to establish greater integration between primary care and specialist cardiology services.
Objectives: Access to specialist cardiology services, either through private cardiology clinics or through outpatient clinics in public hospitals often requires long waiting times of 8 weeks or more. This results in delayed diagnosis and treatment, potentially preventable presentations to Emergency Departments in public hospitals and worry and stress for patients. After referral by a general practitioner, patients are expected to navigate their own care including organising pathology, imaging and electrophysiology testing services, often in multiple locations, in addition to accessing the specialists cardiology appointments.
Methods: HeartConnect was co-designed with specialists and general practitioners (GPs), with input from patients and the Sydney North Health Network (SNHN). HeartConnect is located at Macquarie University Hospital Medical Centre and is overseen by an interdisciplinary steering committee. A mixed-methods study was used to evaluate the HeartConnect service. Patient demographics and details of GP referrals were collected to understand the main reasons for referral. Details of appointments with the HeartConnect cardiology clinic (including timing between referral and appointment, investigations, and cross-referrals) and communication between HeartConnect and referring GPs were collected, in addition to surveys and interviews with GPs, specialists and patients.
Results: Between October 2020 and December 2021, 71 patients (65% male; mean age 56) were referred by 13 primary care practices in the SNHN, and 42 patients (60% male; mean age 53) consented to participate in the evaluation study. The main reasons for referral as provided by GPs included cardiac symptoms (52%), opinion on management (12%), or patient at high risk of cardiovascular disease (10%). For the 42 patients, the time interval between referral and seeing a specialist cardiologist was 4 days (median) and 76% of patients had all tests and imaging performed and reviewed on the same day. Follow-up letters were sent to the referring GPs on the day of appointment at HeartConnect; and within 10 days for the others. There was high acceptability and satisfaction among patients: “Everything was in one place and I didn't have to travel to different locations for various tests…”. GPs felt that the referral pathway had improved with shorter waiting times, and particularly appreciated receiving information about their patients from the specialist HeartConnect clinic in a matter of days: “... the patients have been seen within a couple of days… The letters back have been timely and the cardiologist has, at times, rang and had a chat, when that was relevant.”
Conclusions: HeartConnect shows promise in terms of reducing waiting times, smoothing navigation through care, and enhancing timely communication between specialists and GPs. The model may need significant modifications when implementing into different local contexts. In future work we will describe clinical management decisions and outcomes. The full potential of HeartConnect has not been realised due to ongoing COVID-19 disruptions. A longer-term evaluation would further strengthen the evidence on the benefits of HeartConnect.