Effects of person-centred care in patients with chronic heart failure: the PCC-HF study

Abstract

AimsPerson-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate.Methods and resultsDuring 2008–2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P= 0.16) while retaining ADL (P= 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P= 0.01) and the ADL-level better preserved (P= 0.04). Health-related quality of life and time-to-first readmission did not differ.ConclusionIn this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.

Intervenções não farmacológicas para melhor qualidade de vida na insuficiência cardíaca: revisão integrativa

“…Regarding year of publication, nine articles were dated 2012 (15)(16)18,(20)(21)(22)(29)(30)(31) , followed by years 2011 (n=6) (11)(12)(13)17,19,23,33) , 2010 (n=4) de la salud que tratan de personas con insuficiencia cardiaca. Futuras revisiones sistemáticas con meta-análisis son necesarias para identificar las intervenciones más eficaces para mejorar la calidad de vida de estos individuos.…”

“…Regarding year of publication, nine articles were dated 2012 (15)(16)18,(20)(21)(22)(29)(30)(31) , followed by years 2011 (n=6) (11)(12)(13)17,19,23,33) , 2010 (n=4) (24)(25)32,34) , 2013 (n=3) (14,(27)(28) and 2008 (n=1) (26) . The articles were published in General Cardiology journals (12)(13)(16)(17)(18)20,22,(24)(25)(28)(29)(30)(31)(32)34) , followed by General Clinical journals (14)(15)(26)(27)33) . Two articles were published in Nursing journals (19,23) and one was published in a Nutrition journal (21) (Chart 1).…”

“…As for languages, all articles were published in English. The selected studies were performed in the following countries: USA (n=8) (12,15,17,19,(24)(25)(32)(33) , Sweden (n=2) (18,23) , Germany (n=2) (22,34) , Brazil (n=2) (21,26) , Australia (n=2) (28)(29) , United Kingdom (n=2) (14,31) , Italy (n=2) (16,30) , Spain (n=1) (13) , Taiwan (n=1) (19) and Iran (n=1) (27) . Nurses were the professionals performing the interventions in most studies (12,(14)(15)(19)(20)32) .…”

“…Nurses were the professionals performing the interventions in most studies (12,(14)(15)(19)(20)32) . Another study was performed by nurses in partnership with physical therapists (24) or physicians (22) , followed by nurses working with physical therapists, physicians and occupational therapists (18) . Six studies did not describe which professionals performed the interventions (13,(26)(27)(28)(29)34) .…”

“…Most studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(29)(30)(31)(33)(34) were randomized clinical trials (n=18), followed by two quasi-experimental studies (28,32) . Only one article (27) was a non-randomized clinical trial (4.3%) (Chart 1).…”