Evaluation of a direct access cardiac arrhythmia monitoring service.
BACKGROUND
This paper describes the clinical outcomes from a novel direct access arrhythmia monitoring service.


METHODS
The study was carried out in the north of Scotland. Data was collected over a 29 month period between 18 June 2008 and 8 November 2010 from consecutive cases from two groups of patients, general practitioner (GP) direct access and 'redirected' consultant referrals. Monitor test results, frequency of arrhythmias requiring further care and clinic attendances were recorded. Statistical differences were analyzed using Χ(2), Fisher's and Student's t-test as appropriate with the significance taken at the 0.05 level.


RESULTS
239 patients were referred from 47 GP practices. There were 165 (69%) referrals through the 'direct' and 72 (31%) through the 'redirected' route. The average age was 55.5 ± 16.7 years with 84 (35.1%) males. 127 (53.1%) had a patient activated event recording and the remaining 112 (46.9%) had Holter monitoring. Of the 239 patients, only nine (3.8%) cases required referral to a consultant cardiologist. Of these, three were directly returned to GP care without consultant clinic review. Six patients with significant arrhythmias were reviewed at cardiology clinic. There were no adverse events.


CONCLUSIONS
Direct access for cardiac arrhythmia monitoring seems to provide an effective mechanism for diverting inappropriate or non-essential referrals away from the cardiology clinic.
University of Glasgow, University Avenue, Glasgow, UK.
David A
DA
Skipsey
Fiona M
FM
Dawson
Cathal
C
Breen
Stephen J
SJ
Leslie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D015716:Electrocardiography, Ambulatory / Q000191:economics; D005260:Female; D058006:General Practice / Q000458:organization & administration; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D012040:Regional Health Planning / Q000191:economics / Q000458:organization & administration*; D012606:Scotland; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D014850:Waiting Lists