Impact of managed care on the treatment of atrial fibrillation
Health Maintenance Organizations
In the era of managed care, it has been necessary to develop new and innovative treatment strategies for the treatment of cardiovascular disease. This article examines our experience providing cardiovascular services to a large health maintenance organization (HMO). The focus of this article is on our development and implementation of a systematic approach to the management of atrial fibrillation (AFib), encouraging the active participation of the family practice and internal medicine physicians. With > 22 geographically diverse satellite clinics, the standardization of treatment of a common disease such as AFib is both challenging and difficult. The first objective for Baylor Cardiology was to adapt to such a system and provide an efficient and flexible schedule encouraging communication with the primary care doctor. A telephone consultation service was instituted to provide instant cardiology consultation. The HMO organizational structure allowed us to implement standardized procedures and clinical approaches. Guidelines were implemented to address all practical clinical issues in AFib such as: (1) the necessity for hospitalization; (2) baseline noninvasive studies; and (3) standardization of protime and international normalized ratio (INR) measurements between all the satellite clinics. Also, algorithms for the selection of antiarrhythmic drugs for maintenance of sinus rhythm and rate control are presented.