title: Clinical pathways: adherence issues in complex older female patients with heart failure (HF).
abstract: HF is a leading health care concern, often under-recognized and under-treated in older women. Management of this complex condition frequently requires a multidisciplinary approach and a clinical pathway can be used to deliver coordinated care. This report is based on the intervention/treatment arm (n = 45) of a randomized controlled trial in older women who participated in a multidisciplinary clinic. We describe the development of a clinical pathway for HF and the variance reporting including factors affecting adherence with the pathway. Variances are patient or staff actions that did not meet the expected outcomes. Of the 45 intervention arm female patients, 5 were able to fully complete the program, meaning that all of the intended 12 visits were completed successfully. Thirteen women missed more than three clinic visits, and the rest attended most visits. Variance tracking identified that visits were interrupted most often by patient-related health issues, such as fatigue and pain, which may not be surprising given the expected multiple co-morbidities in this population. Transportation problems were identified as a barrier to attendance. Our study demonstrates that a clinical pathway can be implemented in an older, female population with HF. This report identifies some of the challenges and provides future recommendations for prospective pathway development.
authors.affiliation: University of Ottawa, Regional Geriatric Program of Eastern Ontario, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9. abyszewski@ottawahospital.on.ca
authors.forename: Anna
authors.initials: A
authors.lastname: Byszewski
authors.forename: Nahid
authors.initials: N
authors.lastname: Azad
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Molnar
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009483:Neuropsychological Tests; D010348:Patient Care Team; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000592:standards; D012720:Severity of Illness Index