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Current organization of specialist pulmonary hypertension clinics: results of an international survey.

ABSTRACT: Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February-December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full-time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways.

SUBMITTER: Doyle-Cox C

PROVIDER: S-EPMC6557030 | biostudies-literature | 2019 Apr-Jun

REPOSITORIES: biostudies-literature

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Current organization of specialist pulmonary hypertension clinics: results of an international survey.

Doyle-Cox Carolyn C Nicholson Gail G Stewart Traci T Gin-Sing Wendy W

Pulmonary circulation 20190401 2

Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online Februa ...[more]

PMID: 31106660

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Project description:IntroductionCurrent guidelines for the management of pulmonary arterial hypertension (PAH) recommend regular multi-parametric assessment of a patient's risk of clinical worsening or death, with the goal of achieving/maintaining a low-risk status. This international survey investigated how physicians currently assess risk and compared their clinical gestalt (judgement of risk) with the risk calculated using an algorithm based on the European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines and demonstrated to provide accurate mortality estimates.MethodsPAH-treating physicians from Europe and the United States were surveyed on (1) how frequently they evaluated the recommended risk-assessment parameters and (2) to complete patient record forms (PRFs) with details on 5-7 recent adult PAH patients receiving treatment. For each PRF, physicians provided (1) their gestalt judgement of current risk and (2) details of the risk-assessment parameters measured. In accordance with the published method, measurements for ≥ 2 (of 6 selected) variables were required to calculate risk. Each variable was assigned a score of 1, 2 or 3 according to whether the measurement was within the thresholds for the low-, intermediate- or high-risk categories, as defined in the ESC/ERS guidelines. The average score represented the patient's calculated risk.ResultsIn total, 90 physicians (52 cardiologists, 38 pulmonologists) completed the survey, providing a total of 623 PRFs; of these, 365 (59%) included ≥ 2 measurements required to calculate risk. Among these patients, the percentages assigned to low-, intermediate- and high-risk categories based on gestalt/calculation were 32%/15%, 45%/68% and 22%/17%, respectively. Overall, there was concordance between the gestalt and calculated risk category for 45% of patients. The greatest level of disparity was for patients judged to be at low risk, where 80% were assigned to higher risk categories based on their calculated risk.ConclusionsThe results of this survey demonstrate that multi-parametric risk assessment is being performed in clinical practice, but not always to the extent recommended in the current guidelines. Further study on the utility of more regular measurement is required.FundingActelion Pharmaceuticals Ltd.

Project description:BackgroundThere is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics.MethodsUsing a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location.ResultsOf the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants.ConclusionsThese data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use during patient interviews, and by familiarizing themselves with the potential benefits and risks of commonly used CAM modalities.

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Current organization of specialist pulmonary hypertension clinics: results of an international survey.

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Current organization of specialist pulmonary hypertension clinics: results of an international survey.

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