The Duke Heart Failure Program

The report reveals that the program was conscious of community health ramifications and thus focused on the community as a social determinant of health. For instance, they insisted on dietary and limits if salt intake, among other lifestyle issues such as smoking and rest periods. They also ensured that only patients with reversible conditions were released, to enable closer management of chronically ill patients. They also reduced ER visits to save on the costs for emergency admission. Besides, the program made sure the community was well informed through education. All people who went to the ER due to CHF received health management education and other educational materials such as written guides and manuals to use in the hospital or at home. Overall, DHFP was concerned about promoting the health outcomes of the community. The treatment approach made sure to cover the risk factors such as lifestyle, appropriate medication, and additional intervention through surgery.

Additionally, they adopted a comprehensive and arguably a practical clinical approach to cardiovascular diseases. For instance, they had a notebook that ensured that patients are involved throughout the treatment process. The notebook also fostered comprehensive detailing on progress and management to keep both the patient, practitioners, and family updated. Besides the notebook, the program was conscious of nursing competence. For instance, the consultation was comprehensive where the NP gave the patient a complete physical exam; reviewed all medications are taken, systems, and laboratory results; and checked for allergies.

Nevertheless, I think they failed in failing to have an on-site pharmacist. It may be best for the pharmacist to be at the facility—besides, on-call professionals risk failure to attend due to travel inconveniences. Also, I think NP is overworked. The program ought to utilize more staff, especially NP.

Response to Amy Brainerd

I am excited that you noticed the working hours block at Duke University. It is ideal to ensure that there is always a cardiologist available to attend to cardiologic issues. That way, they increase healthcare access to patients with cardiac issues. Also, having a nurse practitioner is critical, although I think the number of nursing practitioners is not enough. Therefore, besides proving that they have strategies that align with the population approach, I think they should re-evaluate the staffing structure to ensure nurses are not overworked and that all patients are attended effectively.

Response to Jackline Harris

Thank you for making such a long list. You surely took the time to make it. All the things the program has done well are apparent from the list. For instance, I had not noticed that the nursing practitioner works in collaboration (jointly) with the cardiologist until I read your post. I also concur with you that there is a need to employ a dedicated pharmacist. The current system risks delays even when there is a need for urgent medication, causing adverse clinical issues.