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Qualities and shortcomings of the Prado-IC system Qualitative study on the appreciation of the system by primary care physicians Volume 30, issue 4, Juillet-Août 2021

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Authors
1 Service de médecine interne, diabète et maladies métaboliques, clinique médicale B, hôpitaux universitaires de Strasbourg, France
2 Laboratoire d’explorations fonctionnelles, Nouvel Hôpital civil, hôpitaux universitaires de Strasbourg, France
3 Service de cardiologie, Nouvel Hôpital civil, hôpitaux universitaires de Strasbourg, France
* Tirés à part

The management of patients with heart failure (HF) requires scheduled multidisciplinary follow-up, regular monitoring, and therapeutic education. The program to accompany the return home of the IC patient (Prado-IC) is a device created in 2013 by the Social Security allowing support for the patient during his return home thanks to a marked pathway, the aim of which is to reduce hospitalizations. In this context, a qualitative study was conducted to evaluate the Prado-IC system by interviewing primary care physicians in Alsace during semi-directed interviews. The main objective of the study was to evaluate the Prado-IC system in order to highlight its positive and negative aspects and to identify potential areas for improvement. The secondary objectives were to understand the difficulties encountered by general practitioners in the management of CI at home and to draw a parallel between this management and that recommended via the Prado-IC service. Ten general practitioners participated in the study, two women and eight men, between April 2018 and January 2020, allowing data saturation. Within this framework, several results are noteworthy. The tagging of the Prado-IC pathway allows for teamwork and ensures regular follow-up that increases patient focus. This makes it possible to detect cardiac decompensations earlier and reduce hospitalizations. Therapeutic education is reinforced. However, the contribution of the Prado-IC service is low when its pathway is aligned with the work habits of general practitioners and when they are already included in coordinated care organizations. A Prado-IC follow-up is cumbersome for the general practitioner because the early return home coincides with a period of therapeutic adaptation that is difficult to organize in ambulatory care. Prado-IC can lead to communication failures between doctors and nurses, but above all there is a loss of dialogue between private and hospital doctors, as exchanges are made with a health insurance delegate. Finally, patient inclusion in the program is not always adequate. Primary care physicians demand a possibility to monitor the inclusion of patients in order to target the most useful Prado-IC enrolments and would like to be informed of enrolment directly by their hospital colleagues in order to re-establish a medical dialogue. This exchange could be done using a secure messaging system. At home, Prado-IC follow-up could be facilitated by the use of a digital application that would inform the monitoring criteria and interventions of each participant.