Literature Collection

BACKGROUND: The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model. METHODS: We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed. The primary outcome was major adverse cardiovascular events (acute coronary syndromes/stroke/mortality) in a matched population. RESULTS: Among 235 197 consultations for cardiovascular evaluation, 201 453 were completed in the chosen venue within 6 months. The time between consultation and evaluation was similar across venues (community, 35 days [95% CI, 17-65] versus VA, 33 days [95% CI, 19-53]), with comparable delays to diagnostic testing or therapeutic interventions. Patients receiving care in the community were more likely to undergo stress testing (43.2% versus 36.4%, P=1.5×10(-46)) and coronary angiography (23.1% versus 17.4%, P=2.1×10(-51)) within 2 years compared with those treated in the VA Healthcare System. Despite this, patients treated in the community had a significantly higher rate of major adverse events at 2 years (17.6% versus 15.3%, P=5.9×10(-10)) compared with those treated in the VA Healthcare System. CONCLUSIONS: Patients undergoing cardiovascular evaluation in community practices were not evaluated more rapidly than those seen in the VA, though they were more likely to receive initial and repeat diagnostic testing. Adverse events were more common among community-treated patients than those in the VA, suggesting an opportunity to optimize access to care while improving clinical outcomes.

BACKGROUND: Hidradenitis suppurativa (HS) is a painful, chronic, inflammatory skin condition affecting the skin folds. It is frequently misdiagnosed, leading to delays in care and the progression of the disease to permanent scarring. AIM: To understand the level of knowledge and confidence of HCPs in primary care managing patients with HS. To establish their ability to recognise the early signs of HS, awareness of associated comorbidities, and recognition of treatment options available in primary care. DESIGN & SETTING: A survey was distributed to HCPs working in primary care METHOD: The survey was disseminated via weekly GP bulletins distributed by local integrated care boards, the primary care dermatology society mailing lists and at professional events. RESULTS: Of 187 respondents, most (93%) did not have a specialist role in dermatology or a postgraduate qualification in dermatology (69%), 36 (20%) were not doctors, and there was a good geographical spread over the UK. Of the respondents, 74% felt confident diagnosing HS, but only 39% were confident in managing the pain associated with the disease. Perceived confidence did not correlate with understanding the importance of early referral to secondary care where multiple skin sites were affected. CONCLUSION: Further education in diagnosing and managing HS in primary care is needed. Future research could focus on developing a tool to support the diagnosis of HS in primary care and a clear, primary care-focused management guideline for identified patients.