Virtual Heart Failure Clinics for East Galway

Diagnostic services and specialist advice through virtual clinics will be provided in the community through a reconfiguration and re-vamp of the entire Heart Failure service in East Galway. Dr. Chris McBrearty, Associate Specialist in Quality Improvement & SláinteCare Project Manager in Portiuncula University Hospital in Ballinasloe, told the HMI West meeting in Merlin Park.  Maureen Browne reports.

Dr. Chris McBrearty
Dr. Chris McBrearty

He was speaking on “Heart Failure – Innovative Integration of Care Across the Continuum.”

Dr. McBrearty said HeartFailure was costing the Irish state about €660 million a year, according to the most recent figures.

Heart Failure would be the greatest single cardiovascular challenge facing this country in the years to come. Some 90,000 people were living with Heart Failure in Ireland.  In addition, at least 160,000 people were living with asymptomatic Heart Failure and were at risk of progressing to symptomatic Heart Failure, while 10,000 people were newly diagnosed with Heart Failure each year.

There were an estimated 2,680 people living with a Heart Failure diagnosis in the catchment area of Portiuncula University Hospital Ballinasloe and about 5,000 with a pending diagnosis.

Dr. McBrearty said East Galway had been ahead of the curve in trying to care for Heart Failure patients.  The first integrated nursing service for heart failure had been running there for over a decade, recently further enhanced with an inpatient heart failure CNM who dealt specifically with inpatient heart failure education, working with Consultant Cardiologist, Dr. Aidan Flynn.

THere were an estimated 2,680 people living with a Heart Failure diagnosis in the catchment area of Portiuncula University Hospital Ballinasloe and about 5,000 with a pending diagnosis.

“When we saw that there was funding available under Sláintecare we had three separate but integrated initiatives which we wanted to introduce, to improve heart failure care locally in our community.

“We had a ten month waiting list for outpatient echocardiography and we wanted to bring cardiac diagnostics to the community.  We also wanted to further develop our integrated heart failure nursing service and establish Heart Failure Virtual Clinics (HFVC).

“So, we pitched this integrated service and were delighted when we were successful, receiving a total of €331,000.

“The traditional care pathway was for a GP who was concerned about Heart Failure patients to refer to the hospital, seeking an outpatient appointment and/or diagnostic test.  The patients would then get letters in the post, possibly six months later or longer, giving them an appointment.   They might then have to take time off work to attend the hospital or get a carer to drive them.   Then they would wait in the OPD to see a cardiologist and a letter would be sent back to their GP, advising of the next stage of management.

“We will be imminently implementing Heart Failure Virtual Clinics which will give GPs easy access to specialist advice via a telehealth platform. This will remove the need for many patients with heart failure to attend the hospital at all. In future our Consultant Cardiologist post will be 25 per cent dedicated to community services.

We will be imminently implementing Heart Failure Virtual Clinics which will give GPs easy access to specialist advice via a telehealth platform.

“We have four primary care centres where the integrated nurse and diagnostic services will be located.

“We will now be able to provide diagnostics, advice and treatment locally in these centres, which will mean patients will not have to wait for a hospital appointment or travel for their specialist diagnosis and treatment plan. We plan to redistribute our hospital waiting list for diagnostics to our four primary care centres.

“We have very ambitious hopes for projected outcomes.  This is a reconfiguration and revamp of our entire Heart Failure services.  Sláintecare gives us the opportunity to use additional resources in a way that we can use our existing resources better.

“There will still be cases where patients will need to attend hospital and that service will obviously still be available, but we are mainly bringing care for the patient back into the community.   It will be a better service for the patient, take pressure off hospital services and allow them to deal with the more complex cases, while improving service efficiency in the process.

“Over 60 GPs are invited to a meeting in December to discuss with us how the service will be rolled out and engage on service development.

“Many of our patients have co-morbidities and complex needs and so we also need to look further at horizontal integration of services as well as vertical integration. There’s a lot more that can still be done to improve care and outcomes.”