Introduction:
Hospitalizations for heart failure (HF) are the highest single Medicare expenditure. This cost primarily results from readmissions linked to failed self-care. Evidence suggests that effective self-care routines are equivalent to medication in preventing HF exacerbation and hospitalization. Occupational therapists (OT) are well suited to address HF self-care needs by facilitating self-efficacy and adapting patients’ routines, roles and habits. A recent study determined that OT is the only hospital spending category associated with lower HF readmission rates.
Hypothesis:
Occupational therapy has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care.
Methods:
The OT department launched a HF self-care management program as part of process improvement initiatives at an AHA-recognized teaching hospital. An assessment battery was developed which included the following: The Self-Care of Heart Failure Index (SCHFI) v.6.2, Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, and the Montreal Cognitive Assessment. Administration of the OT HF assessment battery to a pilot group of 12 inpatients revealed factors that affect patient adoption and adherence to beneficial self-care management routines. Based on assessment battery data, an outpatient OT program was established. Eleven outpatients were enrolled and completed 3-6 hours of OT treatment. The SCHFI was administered at program evaluation and completion to measure self-care maintenance and confidence. To expand service access, a telehealth self-care program was introduced and a single patient case study was assessed to determine the feasibility and effectiveness of the virtual format.
Results:
Assessment battery data enabled the development of outpatient treatment modules focusing on symptom monitoring, medication management, low sodium diet, activity tolerance and psychosocial strategies. All outpatients who completed the modules demonstrated improved self-care maintenance (ranging from 16-53 points) and half demonstrated improved self-care confidence (ranging from 6-39 points). The patient assessed after completing the telehealth program demonstrated improved self-care maintenance (70 points) and self-care confidence (28 points).
Conclusions:
In conclusion, OT has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. The utilization of a standardized OT HF assessment battery is effective in determining the needs of this population and for guiding the implementation of targeted individualized treatment. Outpatient and telehealth delivery of OT programming is effective in improving self-care for people with HF.
Get Pumped! Palliative Inotropes in Advanced Heart Failure Across the Continuum of Care (SA533)
