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Zheng AD, Cai LL, Xu J. Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure. World J Psychiatry 2023; 13:444-452. [PMID: 37547733 PMCID: PMC10401501 DOI: 10.5498/wjp.v13.i7.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND With the intensification of social aging, the susceptibility of the elderly population to diseases has attracted increasing attention, especially chronic heart failure (CHF) that accounts for a large proportion of the elderly.
AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.
METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received. The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group (SG; n = 62), and those who underwent routine detailed behavioral nursing intervention were included as a control group (CG; n = 54). Patients’ negative emotions (NEs), quality of life (QoL), and nutritional status were assessed using the self-rating anxiety/ depression scale (SAS/SDS), the Minnesota Living with Heart Failure Ques-tionnaire (MLHFQ), and the Modified Quantitative Subjective Global Assessment (MQSGA) of nutrition, respectively. Differences in rehabilitation efficiency, NEs, cardiac function (CF) indexes, nutritional status, QoL, and nursing satisfaction were comparatively analyzed.
RESULTS A higher response rate was recorded in the SG vs the CG after intervention (P < 0.05). After care, the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG (P < 0.05). The post-intervention SAS and SDS scores, as well as MQSGA and MLHFQ scores, were also lower in the SG (P < 0.05). The SG was also superior to the CG in the overall nursing satisfaction rate (P < 0.05).
CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients, and it can not only effectively enhance rehabilitation efficiency, but also mitigate patients’ NEs and improve their CF and QoL.
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Affiliation(s)
- Ai-Di Zheng
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Li-Li Cai
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Jing Xu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Xu T, Clemson L, O’Loughlin K, Lannin N, Dean CM, Koh G. Stepping On after Stroke falls-prevention programme for community stroke survivors in Singapore: A feasibility study. Br J Occup Ther 2020. [DOI: 10.1177/0308022620946640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore. Method A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability. Results Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations. Conclusion The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore; however, caregivers’ participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial.
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Affiliation(s)
- Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Lindy Clemson
- Faculty of Medicine & Health, and ARC Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, Australia
| | - Kate O’Loughlin
- Faculty of Medicine & Health, and ARC Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Catherine M Dean
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Hospitalized patients with heart failure: the impact of anxiety, fatigue, and therapy adherence on quality of life. ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2020; 4:e268-e279. [PMID: 32368682 PMCID: PMC7191938 DOI: 10.5114/amsad.2019.90257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/12/2019] [Indexed: 01/25/2023]
Abstract
Introduction Heart failure (HF) is a major global health problem associated with increased morbidity and mortality and reduced quality of life (QoL). The aim of the study was to assess the impact of anxiety, fatigue and adherence to therapeutic guidelines on HF patients' QoL. Material and methods A hundred and twenty hospitalized HF patients were enrolled in the study. Data collection was performed by completion of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), the Zung Self-Rating Anxiety Scale (SAS) and a questionnaire that measured adherence to therapeutic guidelines. Results Data analysis showed moderate levels of anxiety and high levels of adherence to therapeutic guidelines as well as moderate to large effects of HF on patients' fatigue and QoL. A statistically significant positive linear association was observed between anxiety and QoL (rho > 0.6) as well as fatigue and QoL (rho > 0.3). An increase in the anxiety or fatigue score indicated an increase also in the QoL score, meaning that the more anxiety and fatigue a patient felt the worse the QoL also was. Moreover, a statistically significant negative linear association was observed between adherence to therapeutic guidelines and QoL (rho < -0.2). An increase in adherence score indicated a decrease in QoL score, meaning that the more adherent a patient was the better was the QoL. Conclusions The present findings suggest that QoL may be improved when adherence to therapy is increased and fatigue and anxiety are alleviated.
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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Cavalcante AMRZ, Lopes CT, Brunori EFR, Swanson E, Moorhead SA, Bachion MM, de Barros ALBL. Self-Care Behaviors in Heart Failure. Int J Nurs Knowl 2017; 29:146-155. [PMID: 28523764 DOI: 10.1111/2047-3095.12170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.
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Affiliation(s)
| | - Camila Takao Lopes
- Paulista Nursing School, Federal University of São Paulo (EPE-UNIFESP), São Paulo, São Paulo, Brazil
| | | | | | | | - Maria Márcia Bachion
- College of Nursing, Federal University of Goias (FEN-UFG), Goiânia, Goiânia, Brazil
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Lampert R. Reassuring News for Genetically Tested, Appropriately Treated, Low-Risk LQTS Patients. J Cardiovasc Electrophysiol 2015; 26:859-861. [PMID: 26031829 DOI: 10.1111/jce.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut, USA
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Snowden MB, Steinman LE, Carlson WL, Mochan KN, Abraido-Lanza AF, Bryant LL, Duffy M, Knight BG, Jeste DV, Leith KH, Lenze EJ, Logsdon RG, Satariano WA, Zweiback DJ, Anderson LA. Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research. Front Public Health 2015; 2:213. [PMID: 25964921 PMCID: PMC4410348 DOI: 10.3389/fpubh.2014.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/13/2014] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health. METHODS A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). RESULTS In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence. CONCLUSION Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.
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Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Whitney L. Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kara N. Mochan
- University of Washington School of Nursing with Environmental Health Focus, Seattle, WA, USA
- Adolescent Medicine, Seattle Children’s, Seattle, WA, USA
| | - Ana F. Abraido-Lanza
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Michael Duffy
- Department of Educational Psychology, Counseling Psychology Program, Texas A&M University, College Station, TX, USA
| | - Bob G. Knight
- Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Rebecca G. Logsdon
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | | | - Damita J. Zweiback
- Division of Chronic Disease and Injury Prevention, Michigan Department of Community Health, Lansing, MI, USA
- Healthy Aging Council and Health Equity Council, National Association of Chronic Disease Directors, Atlanta, GA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 2015:CD010523. [PMID: 25733495 PMCID: PMC6486144 DOI: 10.1002/14651858.cd010523.pub2] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. OBJECTIVES To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. DATA COLLECTION AND ANALYSIS Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings. MAIN RESULTS We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process. AUTHORS' CONCLUSIONS Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.
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Affiliation(s)
- Angela Coulter
- University of OxfordHealth Services Research Unit, Nuffield Department of Population HealthOld Road Campus, HeadingtonOxfordUKOX3 7LF
| | - Vikki A Entwistle
- University of AberdeenHealth Services Research UnitHealth Services Building Level 3ForesterhillAberdeenUKAB25 2ZD
| | - Abi Eccles
- University of OxfordDepartment of Primary Care Health Sciences23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sara Ryan
- University of OxfordQuality and Outcomes Research Unit and Health Experiences Research Group23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordUKOX3 7LF
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Fan X, Lv F. Psychosocial factors associated with self-efficacy for managing chronic disease in patients with chronic heart failure. Eur J Cardiovasc Nurs 2014; 15:255-61. [DOI: 10.1177/1474515114566157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Xiuzhen Fan
- School of Nursing, Shandong University, PR China
| | - Fei Lv
- Tianjin Medical College, PR China
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Poor social support is associated with increases in depression but not anxiety over 2 years in heart failure outpatients. J Cardiovasc Nurs 2014; 29:20-8. [PMID: 23321780 DOI: 10.1097/jcn.0b013e318276fa07] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heart failure (HF) is a major health problem in the United States, affecting 5.7 million American adults. Psychosocial distress, in particular depression, contributes to morbidity and mortality in patients with HF. Little is known about the interrelationship among disease severity, social support, and depression. OBJECTIVE The aim of this study was to examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of outpatients with HF. METHODS Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study completed the Beck Depression Inventory-II, the State Trait Anxiety Inventory, and the Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years. RESULTS At baseline, 30% of the patients were depressed and 42% were anxious. Social support amount contributed to changes in depression (P = .044) but not anxiety (P = .856). Depression increased over time for patients who had lower initial social support amount. Depression did not increase for those with higher initial social support amount. Neither New York Heart Association class nor treatment group (placebo or implantable cardioverter defibrillator) interacted with time to predict depression, which indicates that changes in depression were parallel for patients with New York Heart Association class II and class III HF and for those who received implantable cardioverter defibrillators and those who did not. Assessment of patients with HF should include depression and social support. Interventions to enhance social support among patients with HF who have low social support may help alleviate the development of depression. CONCLUSIONS Reducing psychological distress and increasing social support may improve health outcomes among HF outpatients. It is important for studies of HF to include assessment of depression, anxiety, and social support and evaluate their contributions to health outcomes.
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Albano MG, Jourdain P, De Andrade V, Domenke A, Desnos M, d’Ivernois JF. Therapeutic patient education in heart failure: Do studies provide sufficient information about the educational programme? Arch Cardiovasc Dis 2014; 107:328-39. [DOI: 10.1016/j.acvd.2013.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 11/28/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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Otsu H, Moriyama M. 36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients. Health (London) 2014. [DOI: 10.4236/health.2014.67075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Delaney C, Apostolidis B, Bartos S, Morrison H, Smith L, Fortinsky R. A Randomized Trial of Telemonitoring and Self-Care Education in Heart Failure Patients Following Home Care Discharge. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822312475137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with heart failure (HF) who have been discharged from a home care agency are a particularly vulnerable group at risk for poor outcomes and high rehositalization rates. The primary aim of this experimental study was to determine the efficacy of a telemonitoring and self-care education intervention in reducing hospitalization and improving quality of life and patient’s knowledge of HF after home care discharge. Ninety-three participants completed the study. The primary outcome of 90-day post–home care discharge hospitalization was significantly reduced in the intervention group compared to controls (9 vs. 18, p - .046). HF knowledge ( p = .013) and QOL ( p = .004) were significantly increased in intervention group patients in comparison to control group patients’ at the study endpoint.
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Affiliation(s)
- Colleen Delaney
- University of Connecticut School of Nursing, Storrs, CT, USA
| | | | - Susan Bartos
- University of Connecticut School of Nursing, Storrs, CT, USA
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Tung HH, Lin CY, Chen KY, Chang CJ, Lin YP, Chou CH. Self-Management Intervention to Improve Self-Care and Quality of Life in Heart Failure Patients. ACTA ACUST UNITED AC 2012; 19:E9-E16. [DOI: 10.1111/chf.12014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2002] [Revised: 10/07/2012] [Accepted: 10/21/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Chun-Yu Lin
- Tri-Survice General Hospital; Taipei; Taiwan
| | - Kuei-Ying Chen
- Nursing Department; Tungs' Taichung MetroHarbor Hospital; Taichung City; Taiwan
| | - Chien-Jung Chang
- Division of Cardiology; Tungs' Taichung MetroHarbor Hospital; Taichung City; Taiwan
| | - Yu-Ping Lin
- Nursing Department; Oriental Institute of Technology; Pan-Chiao City; Taipei; Taiwan
| | - Cheng-Hui Chou
- National Taipei University of Nursing and Health Science; Taipei; Taiwan
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15
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Ballemans J, Zijlstra GAR, van Rens GHMB, Schouten JSAG, Kempen GIJM. Usefulness and acceptability of a standardised orientation and mobility training for partially-sighted older adults using an identification cane. BMC Health Serv Res 2012; 12:141. [PMID: 22681932 PMCID: PMC3439402 DOI: 10.1186/1472-6963-12-141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 05/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orientation and mobility (O&M) training in using an identification (ID) cane is provided to partially-sighted older adults to facilitate independent functioning and participation in the community. Recently, a protocolised standardised O&M-training in the use of the ID cane was developed in The Netherlands. The purpose of this study is to assess the usefulness and acceptability of both the standardised training and the regular training for participants and O&M-trainers in a randomised controlled trial (NCT00946062). METHODS The standardised O&M-training consists of two structured face-to-face sessions and one telephone follow-up, in which, in addition to the regular training, self-management and behavioural change techniques are applied. Questionnaires and interviews were used to collect data on the training's usefulness, e.g. the population reached, self-reported benefits or achievements, and acceptability, e.g. the performance of the intervention according to protocol and participants' exposure to and engagement in the training. RESULTS Data was collected from 29 O&M-trainers and 68 participants. Regarding the self-reported benefits, outcomes were comparable for the standardised training and the regular training according the trainers and participants e.g., about 85% of the participants in both groups experienced benefits of the cane and about 70% gained confidence in their capabilities. Participants were actively involved in the standardised training. Nearly 40% of the participants in the standardised training group was not exposed to the training according to protocol regarding the number of sessions scheduled and several intervention elements, such as action planning and contracting. CONCLUSIONS The standardised and regular O&M-training showed to be useful and mostly acceptable for the partially-sighted older adults and trainers. Yet, a concern is the deviation from the protocol of the standardised O&M-training by the O&M-trainers regarding distinguishing elements such as action planning. Overall, participants appreciated both trainings and reported benefit.
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Affiliation(s)
- Judith Ballemans
- Department of Health Services, Research, and CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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16
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Stamp KD. Self-care in women with heart failure and the effectiveness of nurse-led educational interventions: a review of the literature. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01115.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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OTSU H, MORIYAMA M. Follow-up study for a disease management program for chronic heart failure 24 months after program commencement. Jpn J Nurs Sci 2011. [DOI: 10.1111/j.1742-7924.2011.00194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Mulligan H, Arps G, Bancroft N, Mountfort R, Polkinghorne A. ‘Living Well with Parkinson’s’: evaluation of a programme to promote self-management. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01082.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smeulders ESTF, van Haastregt JCM, Ambergen T, Stoffers HEJH, Janssen-Boyne JJJ, Uszko-Lencer NHKM, Gorgels APM, Lodewijks-van der Bolt CLB, van Eijk JTM, Kempen GIJM. Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme. PATIENT EDUCATION AND COUNSELING 2010; 81:214-221. [PMID: 20153132 DOI: 10.1016/j.pec.2010.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/30/2009] [Accepted: 01/09/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. METHODS Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. RESULTS In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up. CONCLUSION Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme. PRACTICE IMPLICATIONS These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
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Affiliation(s)
- Esther S T F Smeulders
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
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Smeulders ES, Van Haastregt JC, Ambergen T, Uszko-Lencer NH, Janssen-Boyne JJ, Gorgels AP, Stoffers HE, Lodewijks-van der Bolt CL, Van Eijk JT, Kempen GI. Nurse-led self-management group programme for patients with congestive heart failure: randomized controlled trial. J Adv Nurs 2010; 66:1487-99. [DOI: 10.1111/j.1365-2648.2010.05318.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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