A pilot study: reports of benefits from a 6-month, multidisciplinary, shared medical appointment approach for heart failure patients.

ABSTRACT Heart failure continues to be the leading cause of hospitalization among older adults. Noncompliance with medications, dietary indiscretion, failure to recognize symptoms, and failed social support systems contribute to increased morbidity. Multidisciplinary medical approaches have proven successful for heart failure. In 2004, the Naval Medical Center San Diego started a multidisciplinary shared medical appointment for patients with complicated cases of heart failure. Patients enrolled in the heart failure clinic were monitored prospectively for 6 months. Validated questionnaires concerning satisfaction with care, self-care management, depression, and quality-of-life measures were administered at baseline and 6 months after enrollment. Thirty-nine individuals were enrolled in the clinic, with 33 completing 6 months of follow-up monitoring to date. Hospital admissions for any cause decreased from 11 to eight, whereas congestive heart failure-related admissions decreased from four to two. There was a total of six deaths. During the 6 months of enrollment, use of angiotensin-converting enzyme inhibitors and beta-receptor blockers had absolute increases of 20% and 19%, respectively. Statistically significant improvements were seen in the Beck Depression Inventory and Self-Care Management Index results. A multidisciplinary approach to heart failure patients using the shared medical appointment model can improve patient satisfaction, enhance quality of life, and help reduce hospitalizations while improving provider efficiency.