ESC guidelines 2025 on cardiovascular disease and pregnancy: considerations and future perspectives.

Clinical Relevance There is potential to expand the number of collaborative care and multidisciplinary team-based care models that optometrists are involved in, working at full scope to deliver high quality patient care. Ongoing work to generate research evidence, change policy and secure long-term funding is needed to support implementation. Background Implementation of new models of multidisciplinary team-based care or collaborative care can support quality healthcare delivery and the sustainability of future health systems. Methods This narrative review synthesises research on models of multidisciplinary team-based care or collaborative care that involve optometrists in Australia and New Zealand. Outcomes related to patient health and experience, health service delivery including costs, and practitioner experience including workforce satisfaction were extracted from published evaluations. Additionally, barriers and facilitating factors to implementation were synthesised from identified studies. Results In total, 12 models of care were identified, most were task shifting or task sharing models between optometry and hospital-based ophthalmology for managing eye conditions. These collaborative models were developed to address long waiting lists for hospital-based ophthalmology services, and their implementation resulted in a corresponding decrease in waiting times for appointments. However, patient health outcomes, patient, and practitioner experiences were seldom reported. In primary care settings, models of multidisciplinary team-based care (n =3) were generally well-received by patients and practitioners. However, more objective measures may help quantify the social and economic benefits of these models. Conclusion Despite the impetus for multidisciplinary team-based care, barriers to wider implementation persist. Implementation science can help identify strategies to overcome barriers to adopting evidence-based models of care. Future studies should incorporate economic evaluations, to inform advocacy and policy, to generate system-level change that support health organisations to deliver multidisciplinary team-based care. Finally, future work should consider embedding the patient perspective from outset to ensure that models of care are people-centred.

Background: This study assessed women's views of care in pregnancy, contrasting the experiences and satisfaction of women using different models of care in Victoria, Australia. Methods: A statewide postal survey of women who gave birth during a 2-week period in 1993 was carried out 6 to 7 months after birth. Results: Of 1336 women, 62.5 percent responded, and of these, 62.4 percent rated their antenatal care as very good, 27.7 percent as good, 8.2 percent as mixed, and 1.8 percent as poor or very poor. Although social factors, obstetric factors, and model of care had significant associations with satisfaction in univariate analyses, only model of care, mother's country of birth, and medical risk remained significant in a multivariate analysis using logistic regression. Women were most likely to be satisfied when antenatal care was provided by an obstetrician in private practice or a birth center. When comparisons were restricted to options available to women without private health insurance, using public hospital clinics as the baseline in a multivariate analysis, women were significantly more likely to be satisfied with birth center care, and significantly less likely to be satisfied with shared care. Contributing factors were waiting times, staff seeming rushed, and lack of continuity of caregiver. Conclusion: The expansion of shared antenatal care has not succeeded in improving satisfaction with antenatal care for women in the public health care sector. (BIRTH 24:2, June 1997)

Aboriginal and Torres Strait Islander peoples have knowledge and strengths to promote health and wellbeing in their communities. There is a need to understand how multidisciplinary models of care and partnerships between Aboriginal Community-Controlled Organisations and health service providers can improve outcomes for children with complex needs. The aim of this study is to describe the development, characteristics, and implementation of the Marurra-U Partnership, which is a hybrid (telecare and in-person), multidisciplinary, wraparound model of care for children with complex neurodevelopmental needs and their families in the Fitzroy Valley, Kimberley Region, Western Australia. This study is part of a broader research program that used an Aboriginal Participatory Action Research approach. In-depth interviews were conducted with eleven staff involved in designing and implementing the Marurra-U Partnership. Data were analysed using reflexive thematic analysis. Five themes were constructed relevant to the aim of the study: 1) responding to the need for multidisciplinary, wraparound services for Aboriginal children with complex needs in the Kimberley; 2) strengths, resilience, and future directions of the partnership; 3) principles and characteristics of the model of care; 4) climate change, environmental factors and geographic remoteness as consistent challenges to implementation of the model of care; and 5) shared recognition of the importance of genuine community partnership and leadership to implement models of care like Marurra-U. The Marurra-U Partnership, between an Aboriginal Community-Controlled Organisation and a non-government organisation that provide neurodevelopmental services, has developed a model of care for delivering wraparound, trauma-informed, multi-disciplinary developmental health and capacity-building services. It offers insights for supporting Aboriginal children with complex neurodevelopmental needs and their families in remote Australia.

Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial

Background: Patients with chronic kidney disease are at an increased risk of cardiovascular disease and the associated morbidity and mortality. This patient population is also associated with a substantial cost to the healthcare system with traditional hospital-based care management. The objective of this study is to investigate the cost effectiveness of providing community-based multidisciplinary clinic (MDC) care to this patient population. The goal was to evaluate whether the new model of care is associated with improved patient compliance with medical appointments, and can be delivered effectively within the community in a patient-centred fashion. Design: In this retrospective analysis, participants in this study included patients started within the local regional program who needed dialysis chronically or until death and were followed for at least 3 months prior to dialysis. Comparison was made between those patients attending a hospital based clinic vs. a community based clinic with respect to optimal and suboptimal start rates, use of internet based educational resources was tracked, potassium, haemoglobin, calcium, phosphorus, PTH levels pre dialysis and patient attendance rates were measured as well. Results: The results attained from performing this 15-month retrospective analysis showed that this community based model of care yielded similar results with respect to optimal vs. suboptimal start rates, laboratory parameters at initiation of dialysis, and may have been associated with increased rates of attendance to visits. Conclusions: Our findings show that multidisciplinary care for advanced chronic kidney disease patients can be effectively delivered in a community-based model. This is likely to have significant cost benefits as well as increasing access to care for patients in rural communities or those who prefer to receive their care in a community setting.

Community-Based Palliative Care: Care Transitions and Beyond (SA532)

Background The European Society of Cardiology (ESC) 2018 guidelines for the management of cardiovascular disease during pregnancy1 recommend women with cardiac disease receive pre-pregnancy counselling to facilitate informed decision making. Diagnoses are classified according to the mWHO score1, enabling a quantified risk of maternal morbidity and mortality. This estimated risk can be further adjusted based on individual anatomical, physiological and functional factors, allowing for tailored advice. Aim To evaluate compliance with ESC guidelines1 on pre-pregnancy counselling at LTHT, including providing a quantified risk. Methods Retrospective analysis of electronic records of 476 patients seen in the cardio-obstetrics clinic in LTHT 2014-2020. 241 met the inclusion criteria: 1. Known to LTHT cardiology services prior to first pregnancy 2. Cardiac diagnosis classifiable by mWHO class Results Demographics of our patient cohort are in table 1. 77.2% had congenital heart disease (CHD), and 22.8% acquired disease. 66.8% received pre-pregnancy counselling, 32.3% of these were given a quantified risk (table 2). Rates of pre-pregnancy counselling were similar in CHD and acquired disease (67.6% vs 65.0%). 8 patients attended for pre-pregnancy counselling with no pregnancy to date. There was correlation between a higher mWHO class and a greater percentage of patients receiving pre-pregnancy counselling with risk quantification (figure 1). Median age of first pregnancy was 27, irrespective of whether pre-pregnancy counselling occurred. No patients who became pregnant under age 18 received pre-pregnancy counselling, with the highest incidence of counselling occurring in those aged 35-39 (figure 2). Discussion Those at lower risk in pregnancy (mWHO I and II) were less likely to receive pre-pregnancy counselling, despite being advised in the ESC guidelines. The upward trend as risk increases is encouraging, however as ESC advise pregnancy in mWHO IV is contraindicated1, pre-pregnancy counselling is imperative to facilitate informed choice. ESC recommend pregnancy is first discussed in adolescence when becoming sexually active, so lower maternal age should not be prohibitive to receiving pre-pregnancy counselling. Whilst preferable for this to occur before transition to adult services, it should not be assumed that adult patients have received this information. Limitations include not accounting for patients who have not yet conceived (aside from 8 shown in figure 2), which in some cases could be the result of pre-pregnancy counselling. Furthermore, data collection from clinic letters omits any pre-pregnancy counselling that was not documented or pre-dated the use of electronic records. Conclusions 66.8% of women with known cardiovascular disease were given pre-pregnancy counselling (target 100%). As such, a quality improvement initiative is being established to improve provision of pre-pregnancy counselling to all women of child-bearing age with cardiovascular disease. Conflict of Interest None Reference 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. EHJ 2018;39:3165–3241

BackgroundThere is an evidence-practice gap in osteoarthritis (OA) management which has caused several patients living with the disease are receiving suboptimal medical care. Though there are several guidelines and treatment recommendations published, there is a real need to operationalise such evidence-based guidelines and facilitate their implementation by healthcare professionals in their local health systemsMain textThis work was carried out to outline a patient-centred multidisciplinary osteoarthritis care programme for knee and hip joint osteoarthritis that is applicable in standard clinical practice. A scoping review was conducted to identify an evidence-informed osteoarthritis management strategy, which outlines the optimal manner to treat patients living with osteoarthritis and can be implemented by healthcare professionals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) checklist was used to guide the reporting of this review. Based on this, a “Model of Care” based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including non-pharmacological, pharmacological therapies, psychotherapy, rehabilitation as well as surgery) has been developed aiming to optimise the outcomes. The goals and principles have been identified as well as the key performance indices. An algorithm for the multidisciplinary management of osteoarthritis has been developed.ConclusionThe developed osteoarthritis care programme (OACP) provided a “Model of Care” for people living with OA which can be implemented in standard practice. The results will give insight into the features, performance, results, and outcome measures assessed. It will also guide future research towards how “Model of Care” can be patient-centred and tailored to the individual medical status.

Endometriosis is a chronic, painful disease without a cure. Due largely to chronic pain, endometriosis can lead to significant physical, mental, relationship, and financial burdens. Within the conventional single provider model of care—in which the patient is primarily taken care of by her physician and complementary strategies based on psychology, nutrition, pain medicine, pelvic physical therapy, and so on may not be readily available in a coordinated manner—most women with endometriosis live with unresolved pain and the consequences of that pain. We therefore propose that there is an urgent need to search for alternative models of care. In the current paper, we discuss our experiences with an model of care in which we adopt a long-term, patient-focused, and multidisciplinary chronic care model for women with endometriosis. Our objective is to improve long-term clinical outcomes for women with endometriosis. For geographical areas and healthcare systems in which it is feasible, we propose consideration of this multidisciplinary model of care as an alternative to the single provider model and offer guidance for those considering establishment of such a program. We also initiate a conversation about which clinical outcomes pertaining to endometriosis are important and should be tracked to assess the efficacy and value of multidisciplinary and other endometriosis healthcare models.

BackgroundTreat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA), this strategy has become recognized as a...

Introduction: The University of Virginia's (UVA's) adult cystic fibrosis (CF) program implemented a rapid and successful transition to telemedicine care mid-March of 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. In May 2020, the adult UVA CF program redesigned the care model to adjust to the reopening of ambulatory operations and introduced hybrid clinics. The goal remained to minimize person-to-person contacts for patients and care team members (CTMs) while ensuring patient access to quarterly, coproduced, synchronous, multidisciplinary CF care, similar to pre-COVID-19 era regular CF care. Methods: Using quality improvement tools, the UVA adult CF program created a standardized hybrid model of care for in-clinic visits, which included combined components of in-person and synchronous virtual interactions with members of the multidisciplinary team. Results: A total of 16 hybrid visits occurred between May 14 and June 11, 2020. All hybrid visits were multidisciplinary and fulfilled patient requests to see CTMs. All patients seen by hybrid encounter participated in coproduced agenda setting, underwent spirometry, and obtained blood work; 75% provided sputum for surveillance culture. Each hybrid visit type was attended by an average of four CTMs and amounted to 63 separate interactions. Of these interactions, 28 were completed virtually, reducing in-person contacts and personal protection equipment utilization by 44% compared with a fully in-person model of care. Conclusions: Combining in-person and telehealth components in a multidisciplinary CF care model reduces patient and staff interactions and personal protective equipment utilization. The hybrid model of in-person/remote combined care enables reliable access to biological data to support medical decision making while mitigating the risks of person-to-person contact for patients and staff.

Approximately one in five Australians who undergo total knee replacement (TKR) experience persistent postoperative pain. There are currently no known effective and cost-effective multidisciplinary models of care in Australia to address this. We are developing the 'Early Pain Intervention after Knee Replacement' (EPIK) model of care, adapted from 'Support and Treatment After Replacement' (STAR) care pathway. STAR was developed in the United Kingdom (UK) and shown to be effective and cost-effective in the UK context. Extensive consumer and clinician engagement informed the development of the EPIK model of care, tailored to the Australian health system and geographical context to address this critical gap. To co-design the 'Early Pain Intervention after Knee replacement' (EPIK) model of care for people with persistent pain after TKR. We used Experience-Based Co-Design (EBCD) methodology to co-design EPIK, a telehealth model of care providing remote care coordination for people with persistent pain after TKR. Three online Zoom workshops were conducted with key stakeholders, including consumers with lived experience, clinicians (orthopaedic surgeons, physiotherapists, general practitioners, psychologists and a rehabilitation physician), and EPIK investigators. Workshop 1 explored consumer perspectives on the EPIK model of care assessment and follow-up. Workshop 2 determined the feasibility and roles of clinicians in the EPIK model of care delivery. Workshop 3 brought together consumers, clinicians, and researchers to refine and finalise the EPIK model of care. Using EBCD methodology and inductive framework analysis, themes were derived iteratively. Across consumer and clinician workshops, consensus was reached through facilitated discussions where stakeholders actively contributed to prioritisation activities and iterative refinement of model components. Twenty-one individuals participated in the workshops, comprising nine consumers and 12 clinicians from the Australian Capital Territory, New South Wales, Tasmania, and Western Australia, alongside five EPIK Investigators. Workshop 1 with consumers highlighted the need for clearer definition of communication processes, patient education and coaching strategies, and the role of the EPIK care coordinator to ensure consistent information and coordinated support throughout the model of care delivery. Workshop 2 with clinicians focused on telehealth assessments, escalation of clinical pathways, referrals, and psychological support. The final workshop reached consensus on its components and delivery, emphasising the importance of patient advocacy, reassurance and continuity of personalised care. Through meaningful end-user involvement, co-design informed the development of the EPIK model of care. The effectiveness, cost-effectiveness and safety of EPIK will be evaluated in a randomised controlled trial. Two consumer co-authors (T.G. and B.L.) guided the development of the preliminary model of care and trial protocol. Consumers with lived experience of persistent pain after TKR participated throughout the co-design process. ACTRN12625001029482p (Australian and New Zealand Clinical Trials Registry). Registered on 17 September 2025.

BackgroundA care gap exists between the health care needs of older persons with fragility fractures and the therapeutic answers they receive. The Fracture Prevention Service (FPS), a tailored in-hospital model of care, may effectively bridge the osteoporosis care gap for hip-fractured older persons. The purpose of this study was to evaluate the efficacy of the FPS in targeting persons at high risk of future fracture and to improve their adherence to treatment.MethodsThis was a prospective observational study conducted in a teaching hospital with traumatology and geriatric units, and had a pre-intervention and post-intervention phase. The records of 172 participants were evaluated in the pre-intervention phase, while data from 210 participants were gathered in the post-intervention phase. All participants underwent telephone follow-up at 12 months after hospital discharge. The participants were patients aged ≥65 years admitted to the orthopedic acute ward who underwent surgical repair of a proximal femoral fracture. A multidisciplinary integrated model of care was established. Dedicated pathways were implemented in clinical practice to optimize the identification of high-risk persons, improve their evaluation through bone mineral density testing and blood examinations, and initiate an appropriate treatment for secondary prevention of falls and fragility fractures.ResultsCompared with the pre-intervention phase, more hip-fractured persons received bone mineral density testing (47.62% versus 14.53%, P<0.0001), specific pharmacological treatments (48.51% versus 17.16%, P<0.0001), and an appointment for evaluation at a fall and fracture clinic (52.48% versus 2.37%, P<0.0001) in the post-intervention phase. Independent of some confounders, implementation of the FPS was positively associated with recommendations for secondary fracture prevention at discharge (P<0.0001) and with 1-year adherence to pharmacological treatment (P<0.0001).ConclusionThe FPS is an effective multidisciplinary integrated model of care to optimize identification of older persons at highest risk for fragility fracture, to improve their clinical management, and to increase adherence to prescriptions.

The treatment of cancer requires that health care providers and caregivers from many disciplines work together on the intertwined physical, psychological, social and spiritual needs of oncology patients. Providing a conceptual framework explaining how the members of multidisciplinary oncology treatment teams may best interact with each other and the patient helps drive patient-centered care and clarifies the roles of specific team members at various times over the course of treatment. The ABC model of multidisciplinary care in cancer treatment describes the roles of the active caregivers (for example, physicians or nurses), basic supportive caregivers (for example, psychologists or chaplains) and community support (for example, advocacy groups or hospital staff) providing the full continuum of the cancer treatment experience. Teams trained in the ABC model should better understand the function and importance of each member's role, increase patient involvement and satisfaction with treatment, and ultimately improve patient outcomes.

Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed.