Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol

Abstract

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure

“…25 The study was approved by the university institutional review board and the hospital ethical committees. All subjects provided written informed consent.…”

“…cancer) which limited the patient's SM capacity. 25 With the exception of the Mini-Cog™ test, all other clinical diagnoses (e.g., NYHA, depression, cirrhosis, chronic renal failure, or terminal illness) were collected and confirmed from patients' medical records in hospital, primary care, and specialty clinics. We were unable to obtain the effect size from similar studies in comparable populations or from a pilot study.…”

Mechanism of engaging self-management behavior in rural heart failure patients

“…This secondary analysis used the baseline data from a randomized controlled trial titled “Patient AcTivated Care at Home (PATCH)” which was intended to examine the feasibility and efficacy of a 12-week home-based intervention to improve HF SM adherence(Young et al 2014). The study was approved by the University of Nebraska Medical Center Institutional Review Board (IRB PROTOCOL # 228-13-EP) and hospital ethical committees.…”

“…cancer) which limited the patient’s SM capacity. The details regarding sample and setting has been previously reported (Young et al 2014). To detect a medium effect correlation ( r = 0.28) using a two sided test, 5% significance level test (α=0.05) with power 80% power ( β =0.2), the required sample size is approximately 98 (n=98) (Hulley et al 2013).…”

Healthcare Engagement and Encounters in a Rural State: A Focus Group Study

“…[2][3][4]8,9 In addition, patients admitted to rural hospitals with diseases, such as congestive heart failure, are more likely to be readmitted to the hospital than patients in urban areas. 10,11 Studies have shown that rural areas have their own cultural patterns, which can influence their health care attitudes and health outcomes. [11][12][13][14] A series of patient interviews conducted in Australia and western states in the US showed that people were self-reliant out of necessity due to lack of access to health care or because of poor provider-patient relationships.…”