The Netherlands Heart Journal – Innovatieve cardiologische poliklinieken in Nederland

In the Netherlands, 1.4 million people suffer from cardiovascular disease. This number will increase with more than 30% over the next 20 years. To ensure access to outpatient clinics at acceptable costs, the efficiency of outpatient health care warrants optimisation. Rapid-access or fast-track cardiology services not only enable dealing with the rising number of outpatients, but also meet patients’ expectations such as short waiting time, direct evaluation of the test results and prompt therapy if necessary.

Rapid-access clinics have shown to reduce hospitalisations, are more cost-effective and are viewed positively by patients and general practitioners []. It can be anticipated that rapid access reduces the time that a patient is unable to work and therefore positively affects reintegration and reduces the costs of social services. In addition, a diagnostic ‘one-stop shop’ (all diagnostic tests are performed during one visit) is efficient since a time-fragmented process results in unnecessary re-scheduling and repeated medical interviews.

This has been recognised by Lenderink and Balkestein, who started a Dutch fast-lane outpatient clinic in 2007. In their article, published in the current issue, they describe the long-term outcome of this initiative. Their study shows that a rapid-access and fast-track cardiology clinic for the evaluation of suspected cardiac disease, is safe, which is in keeping with other studies. High efficiency was shown since a cardiac origin of the complaints could be excluded in 50% of patients in a single visit.

The predictability of health-care demand plays a pivotal role in any efficient clinical process. As the authors have shown, the predominant reasons for referral are three complaints that account for 85% of the patients []. Using these data, specific care pathways can be planned before the patient visits the clinic, resulting in a more effective use of resources and a shorter time for the diagnostic evaluation. For example, the authors suggest Holter registration prior to the consultation in patients with palpitations which is an excellent example of innovative modification of the health-care process.

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