title: Heart failure in primary care: co-morbidity and utilization of health care resources.
abstract: BACKGROUND
  In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization.
  
  
  OBJECTIVE
  To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs.
  
  
  METHODS
  Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated.
  
  
  RESULTS
  One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost).
  
  
  CONCLUSIONS
  Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.
authors.affiliation: Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Carmona
authors.forename: Luis M
authors.initials: LM
authors.lastname: García-Olmos
authors.forename: Pilar
authors.initials: P
authors.lastname: García-Sagredo
authors.forename: Ángel
authors.initials: Á
authors.lastname: Alberquilla
authors.forename: Fernando
authors.initials: F
authors.lastname: López-Rodríguez
authors.forename: Mario
authors.initials: M
authors.lastname: Pascual
authors.forename: Adolfo
authors.initials: A
authors.lastname: Muñoz
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Salvador
authors.forename: José L
authors.initials: JL
authors.lastname: Monteagudo
authors.forename: Ángel
authors.initials: Á
authors.lastname: Otero-Puime
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016527:Drug Costs; D004526:Efficiency; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006295:Health Resources / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000145:classification / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000191:economics; D059017:Primary Care Nursing / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013030:Spain
chemical_list: D055553:Prescription Drugs
keywords: ACG; co-morbidity; heart failure; primary care; resource utilization.