Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization

Abstract

Background Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post HF hospitalization have not been extensively evaluated. Methods and Results Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African-American, 34% Caucasian, 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35,000 for 49% of patients. An appointment near the patient’s home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of co-payment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of co-pay (46%), and transportation to appointment (39%). There were significant differences (p=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared to low-ranking interventions related to time (weekend appointment, appointment after 5pm) and telemedicine. Conclusions Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient’s home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.

Confronting Challenges in Reducing Heart Failure 30‐Day Readmissions: Lessons Learned With Implications for Evidence‐Based Practice

“…Recent HF literature reports that patient preference or goal‐related outcomes remain scarce (Blom et al., ). The scant evidence revealed that an appointment close to home and a reminder message were the top‐rated facilitators for HF follow‐up care, closely followed by transportation to the appointment and elimination of a copay (Breathett et al., ). To augment the lack of patient preference literature, findings from the literature that summarized barriers to HF management were considered and included the following: (a) lack of knowledge regarding HF diagnosis and prognosis, (b) problems navigating and accessing support services for health and home, and (c) problems related to accessing emergency care (Browne, Macdonald, May, Macleod, & Mair, ).…”

Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis

“…[38, 41] Second, patient-level issues related to socioeconomic position occur more frequently in racial/ethnic minorities. [42, 43] Usage of a social worker or community liaison has assisted with meeting patient specific needs. [40, 44–47] Also treating the patient as an individual rather than as a collective group of people may reduce racial/ethnic disparities in care.…”

Same Story, Different Disease

“…6 Patient-centered work reveals that appointments have been missed secondary to inability to obtain affordable transportation to appointments. 10 Presumed non-adherence in African-American heart transplant recipients may also be secondary to genetic polymorphisms that lead to higher metabolism of immunosuppressive medications, which require higher dosage to attain therapeutic levels. 11…”