Abstract 11098: Comparing Perspectives Between Patients, Caregivers, and Clinicians on Heart Failure Management
Introduction: Although significant effort has been devoted to reducing readmissions for heart failure (HF) patients, little is known about the role of patient-centered factors. The goal of this study was to obtain the perspectives of HF patients, their caregivers, and their health care providers. Understanding these unique perspectives may lead to better strategies to improve transitions and reduce readmissions.
Methods: We performed freelisting--an anthropological technique in which participants list items in response to a question--with patients admitted for HF, their caregivers, and clinicians (physicians, nurses, physician assistants, social workers, and care coordinators) at the University of Pennsylvania Health System. We asked clinicians and patients about how patients manage HF at home and what makes it difficult to manage HF. We asked caregivers what they did to help with HF management and about challenges at home. Results were analyzed in Anthropac© using cultural consensus analysis. Salience indices (a measure of the most important words for defining the domain of interest) were calculated, and perspectives between groups were compared.
Results: We interviewed 50 patients, 30 caregivers, and 62 clinicians. Patients identified taking medications appropriately, exercise, and nutrition behavior as important for home HF management; clinicians cited daily weight checks, medications, restricting sodium, and restricting fluids; caregivers named medicine, cooking, and household chores. Patients listed activities of daily living, steps, physical limitations, and diet behaviors as difficulties in home management; clinicians named social support/caregiver, following a healthy diet, and education/knowledge of disease; caregivers listed moving around, personal characteristics, and daily activities.
Conclusion: Patients and clinicians identify similar key tasks of home HF management, although caregivers identify different ones. Clinicians differ with patients and caregivers in their ideas about difficulties with HF management. These discrepancies may reflect lack of clinician attention to functional status and limit the effectiveness of HF management.
- Heart failure
- Disease management
- Quality of medical care
- Healthcare delivery systems
- Health services research
- © 2013 by American Heart Association, Inc.