Facilitators and Barriers in Managing Elderly Chronic Heart Failure Patients in Primary Care: A Qualitative Study of Medical Personnel’s Perspectives Using the Socio-Ecological Model

Abstract

Background Primary care has been identified as a key factor in facilitating timely diagnosis and effective management of congestive chronic heart failure (CHF) in older patients. Understanding the current status of CHF management in community health care can therefore be effective in reducing the disease burden of CHF. Objectives The aim of this study was to evaluate the existing state of CHF services offered by healthcare facilities and to identify the primary obstacles faced by community medical personnel in China. Methods In this interpretive study, the social ecological model (SEM) was employed to facilitate interviews conducted using a semi-structured interview guide. Each participant underwent an interview lasting between 45 and 60 minutes. Thematic analysis was utilized for data analysis. Results This study incorporated a cohort of 30 participants. Facilitators and barriers were identified within the five domains of the SEM. (1) individual level: medical staff lack knowledge and experience in CHF management while patients’ weak health awareness. (2) interpersonal level: insufficient support from the patients’ family and lack of trust in community hospitals and health workers. (3) organizational level: inadequate medical knowledge and training programs for medical staff, shortage of medical staff and weak teamwork and few health promotion channels. (4) community level: Lack of regular screening and follow-up, medical equipment and an information technology-assisted monitoring system. (5) public policy level: lack of policy support, funding subsidies, national guidelines adapted to the local context and low medical insurance reimbursement rate. Conclusion There are many impediments to chronic disease management in the community, so it is vital to improve public understanding of CHF, as well as to improve the quality of community health equipment and services, to improve reciprocal referral mechanisms between hospitals and the community, and to develop policies on chronic disease management for chronic older people.