title: Enhanced access to primary care for patients with congestive heart failure. Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.
abstract: OBJECTIVE
  To determine whether enhanced access to primary care affects the diagnostic evaluation, pharmacologic management, or health outcomes of patients hospitalized with congestive heart failure (CHF).
  
  
  METHODS
  Multisite randomized, controlled trial.
  
  
  METHODS
  Nine Veterans Affairs medical centers.
  
  
  METHODS
  443 patients who were hospitalized with a diagnosis of CHF.
  
  
  METHODS
  Enhanced access to primary care, including assignment of a primary care nurse and physician, increased telephone contact, additional outpatient visits, and patient education.
  
  
  METHODS
  Diagnostic evaluation, pharmacologic management, health-related quality of life, and hospital readmission rates.
  
  
  RESULTS
  About 80% of patients who had enhanced access to care and patients receiving usual care underwent recommended evaluation of left ventricular ejection fraction. Among the subset of patients for whom an angiotensin-converting enzyme (ACE) inhibitor was recommended (i.e., ejection fraction < 40%), three quarters of the patients in both the enhanced access and usual care groups received the drug (75% vs. 73%; P > 0.2). Enhanced access to primary care did not improve quality of life and increased hospital readmissions, with an average of 1.5 +/- SD 2.0 readmissions per 6 months of follow-up for patients who had enhanced access compared with 1.1 +/- SD 1.8 for those who received usual care (P = 0.02).
  
  
  CONCLUSIONS
  Compliance with recommended CHF testing and treatment guidelines was equally high in both study groups. Enhanced access to primary care did not improve patients' self-reported health status and was associated with more frequent hospitalizations.
authors.affiliation: VA Medical Center, Duke University Medical Center, Durham, NC, USA. Oddon001@mc.duke.edu
authors.forename: E Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: M
authors.initials: M
authors.lastname: Weinberger
authors.forename: A
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: P
authors.initials: P
authors.lastname: Landsman
authors.forename: W
authors.initials: W
authors.lastname: Henderson
mesh_terms: D019468:Disease Management; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006787:Hospitals, Veterans; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011788:Quality of Life; D014481:United States