Heterogeneity of heart failure management programs in Australia.
BACKGROUND
Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.


OBJECTIVE
To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.


METHODS
Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.


RESULTS
All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.


CONCLUSIONS
Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.
Driscoll
Andrea
A
School of Nursing, Deakin University, Melbourne, Australia.
Worrall-Carter
Linda
L
McLennan
Skye
S
Dawson
Anna
A
O'Reilly
Jan
J
Stewart
Simon
S
D000359:Aftercare / Q000458:organization & administration; D001315:Australia / Q000453:epidemiology; D019985:Benchmarking / Q000458:organization & administration; D019090:Case Management / Q000458:organization & administration*; D002423:Cause of Death; D003153:Community Health Services / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005380:Financing, Government; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control*; D006742:Hospital Bed Capacity; D006801:Humans; D009017:Morbidity; D009313:National Health Programs / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration; D011795:Surveys and Questionnaires