• E Z Oddone, M Weinberger, A Giobbie-Hurder, P Landsman, and W Henderson.
• VA Medical Center, Duke University Medical Center, Durham, NC, USA. Oddon001@mc.duke.edu
• Eff Clin Pract. 1999 Sep 1; 2 (5): 201-9.

ObjectiveTo determine whether enhanced access to primary care affects the diagnostic evaluation, pharmacologic management, or health outcomes of patients hospitalized with congestive heart failure (CHF).DesignMultisite randomized, controlled trial.SettingNine Veterans Affairs medical centers.Patients443 patients who were hospitalized with a diagnosis of CHF.InterventionEnhanced access to primary care, including assignment of a primary care nurse and physician, increased telephone contact, additional outpatient visits, and patient education.Main Outcome MeasuresDiagnostic evaluation, pharmacologic management, health-related quality of life, and hospital readmission rates.ResultsAbout 80% of patients who had enhanced access to care and patients receiving usual care underwent recommended evaluation of left ventricular ejection fraction. Among the subset of patients for whom an angiotensin-converting enzyme (ACE) inhibitor was recommended (i.e., ejection fraction < 40%), three quarters of the patients in both the enhanced access and usual care groups received the drug (75% vs. 73%; P > 0.2). Enhanced access to primary care did not improve quality of life and increased hospital readmissions, with an average of 1.5 +/- SD 2.0 readmissions per 6 months of follow-up for patients who had enhanced access compared with 1.1 +/- SD 1.8 for those who received usual care (P = 0.02).ConclusionsCompliance with recommended CHF testing and treatment guidelines was equally high in both study groups. Enhanced access to primary care did not improve patients' self-reported health status and was associated with more frequent hospitalizations.

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