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. 2014 Dec;69(10):666-71.
doi: 10.6061/clinics/2014(10)03.

Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

André C Marques  1 , Daniela Calderaro  1 , Pai C Yu  1 , Danielle M Gualandro  1 , Gabriel A L Carmo  1 , Fernanda R Azevedo  1 , Adriana F Pastana  1 , Eneas M O Lima  1 , Maristela Monachini  2 , Bruno Caramelli  1
Affiliations

Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

André C Marques et al. Clinics (Sao Paulo). 2014 Dec.

Abstract

Objectives: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.

Methods: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.

Results: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).

Conclusions: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Association between adherence to recommendations and clinical outcomes.
See this image and copyright information in PMC

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