scholarly journals Transitional care from the hospital to the home in heart failure: implementation of best practices

2022 ◽  
Vol 75 (1) ◽  
Author(s):  
Michele Nakahara-Melo ◽  
Ana Paula da Conceição ◽  
Diná de Almeida Lopes Monteiro da Cruz ◽  
Vilanice Alves de Araújo Püschel
Keyword(s):  
Heart Failure ◽  
Best Practices ◽  
Hospital Discharge ◽  
Transitional Care ◽  
Self Care ◽  
Telephone Contact ◽  
Before And After ◽  
Care Practices ◽  
Implementing Strategies

ABSTRACT Objectives: Assess the compliance of the implementation of better evidence in the transitional care of the person with heart failure from the hospital to the home. Methods: Evidence implementation project according to the JBI methodology in a cardiology hospital in São Paulo. Six criteria were audited before and after implementing strategies to increase compliance with best practices. 14 nurses and 22 patients participated in the audits. Results: In the baseline audit, compliance was null with five of the six criteria. Strategies: training of nurses; reformulation of the hospital discharge form and guidance on self-care in care contexts; and making telephone contact on the 7th, 14th and 21st days after discharge. In the follow-up audit, there was 100% compliance with five of the six criteria. Conclusion: The project made it possible to increase the compliance of transitional care practices in people with heart failure with the recommendations based on the best evidence.

Abstract TP366: Significant Reduction in Readmission Using Transitions Nurse

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kiersten Espaillat ◽  
Paula Buckner
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Adult Patients ◽  
Care Coordinator ◽  
Readmission Rates ◽  
Before And After

In an effort to reduce early hospital readmissions, Vanderbilt University Medical Center (VUMC) implemented a transitional care coordinator (TCC) to provide careful coordinated follow up care for stroke patients after hospital discharge. The aim of this study is to compare all cause thirty- day readmission rates of adult patients with a primary diagnosis of stroke before and after the implementation of a stroke services TCC. All adult patients admitted to VUMC with a primary diagnosis of stroke; ischemic, hemorrhagic, and TIA; and readmitted within the first thirty days following hospital discharge between January-June of 2015, 2016, 2017, & 2018 were analyzed. Readmission data from 2015 & 2016, prior to the implementation of the TCC was compared to readmission data from 2017 & 2018, after the TCC was implemented. A total of 1911 charts were reviewed for the timeframe January-June of 2015-2018. In 2015 there were 369 stroke admissions and 120 (33%) were readmitted and in 2016 there were 474 stroke admissions and 112 (24%) readmissions, before the TCC role was implemented. In 2017 there were 540 stroke admissions and 62 (11%) were readmitted and in 2018 there were 528 stroke admissions and 74 (14%) readmissions, after the TCC role was implemented. Hospital readmissions were reduced significantly after implementing a TCC.

scholarly journals Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey

2019 ◽  
Vol 16 (9) ◽  
pp. 1625 ◽  
Author(s):  
Rosalia Santesmases-Masana ◽  
Luis González-de Paz ◽  
Elvira Hernández-Martínez-Esparza ◽  
Belchin Kostov ◽  
Maria Dolors Navarro-Rubio
Keyword(s):  
Heart Failure ◽  
Health Literacy ◽  
Chronic Heart Failure ◽  
Primary Healthcare ◽  
Self Care ◽  
Cross Sectional ◽  
Heart Failure Patients ◽  
Care Practices ◽  
Primary Healthcare Centers

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

scholarly journals Evolution of self-care in patients with heart failure at the first outpatient return and three months after hospital discharge

2021 ◽  
Vol 29 ◽  
Author(s):  
Debora Cristine Previde Teixeira da Cunha ◽  
Lidia Aparecida Rossi ◽  
Carina Aparecida Marosti Dessote ◽  
Fabiana Bolela ◽  
Rosana Aparecida Spadoti Dantas
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Self Care ◽  
Decompensated Heart Failure ◽  
Public Hospitals ◽  
Significance Level ◽  
Brazilian Version ◽  
Patients With Heart Failure ◽  
Student’S T

Objective: to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1). Method: an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student’s t test and paired distribution (McNemar) with a significance level of 0.05. Results: we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales. Conclusion: self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.

scholarly journals Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021966 ◽  
Author(s):  
Federica Dellafiore ◽  
Cristina Arrigoni ◽  
Francesco Pittella ◽  
Gianluca Conte ◽  
Arianna Magon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Chronic Heart Failure ◽  
Real World ◽  
Self Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Caregiver Relationship

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort’s demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients’ discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients’ self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

scholarly journals Knowledge, attitudes and self-care practices of patients with glaucoma in uThungulu in KwaZulu-Natal

2018 ◽  
Vol 77 (1) ◽  
Author(s):  
Aita V. Aghedo ◽  
Boikhutso Tlou ◽  
Saajida Mahomed
Keyword(s):  
Self Care ◽  
Cross Sectional Study ◽  
Good Knowledge ◽  
Cross Sectional ◽  
Glaucoma Diagnosis ◽  
Kwazulu Natal ◽  
Strict Compliance ◽  
Males And Females ◽  
Care Practices

Background: Glaucoma remains one of the leading causes of blindness in South Africa. Early detection, effective treatment and strict compliance with treatment are instrumental to prevent further damage to the optic nerve and thus preserve vision.Aim: The purpose of this study was to assess the knowledge, attitude and self-care practices of patients with glaucoma in KwaZulu-Natal.Setting: The study was conducted in the ophthalmology outpatient department of a public hospital and a private ophthalmology practice in the uThungulu district.Methods: This was an observational, analytic, cross-sectional study. Structured questionnaires assessing knowledge, attitudes and self-care practices were administered to patients presenting for follow-up glaucoma management.Results: The median age of the 384 patients in this study was 60 (interquartile range [IQR] 48.5–69.5) and 59 years (IQR 49.0–66.5) for males and females, respectively (p > 0.05). Two hundred and thirty-eight (62.0%) patients had good knowledge of glaucoma. Age, gender and duration of glaucoma diagnosis were significantly associated with good knowledge of glaucoma. Three hundred and forty-four (89.6%) patients reported having good self-care practices. Patients over the age of 65 years were significantly less likely to have good self-care practices compared to patients aged 26–45 years (odds ratio [OR]: 0.2, confidence interval [CI]: 0.1–0.6, p = 0.01). Good knowledge of glaucoma was significantly associated with good self-care practices of glaucoma (p < 0.001).Conclusion: Elderly patients do not have sufficient knowledge of glaucoma and have poor self-care glaucoma practices. It is important to involve family members of these patients in the education and counselling of glaucoma to facilitate improved disease management.

scholarly journals An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients

2015 ◽  
Vol 23 (4) ◽  
pp. 753-768 ◽  
Author(s):  
Sophie Boisvert ◽  
Alexandra Proulx-Belhumeur ◽  
Natalia Gonçalves ◽  
Michel Doré ◽  
Julie Francoeur ◽  
...  
Keyword(s):  
Heart Failure ◽  
Literature Review ◽  
Self Care ◽  
Theoretical Background ◽  
Nursing Interventions ◽  
Behavioral Strategies ◽  
Heart Failure Patients ◽  
Final Sample ◽  
Critical Components

AbstractObjective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients.Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients).Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints.Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.

scholarly journals Depression risk in patients with heart failure in primary care practices in Germany

2016 ◽  
Vol 28 (11) ◽  
pp. 1889-1894
Author(s):  
Marcel Konrad ◽  
Jens Bohlken ◽  
Michael A Rapp ◽  
Karel Kostev
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Insurance ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Study Population ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

scholarly journals Medication Adherence and Associated Factors among Chronic Heart Failure Clients on Follow Up Oromia Region, West Ethiopia

2019 ◽  
Vol 17 (2) ◽  
pp. 104-114
Author(s):  
Getahun Fetensa ◽  
Birhanu Yadecha ◽  
Tadesse Tolossa ◽  
Tariku Tesfaye Bekuma
Keyword(s):  
Heart Failure ◽  
Medication Adherence ◽  
Chronic Heart Failure ◽  
Health Education ◽  
Study Design ◽  
Associated Factors ◽  
Multivariable Analysis ◽  
Self Care ◽  
P Value

Background: Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. Methods: Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. Results: A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. Conclusion and Recommendation: Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.

33 Effectiveness of Caregiver-oriented Transitional Care Program (CTCP) in Promoting Preparedness of Caregivers for Home Care of Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S23-S24
Author(s):  
Jun Jun A Dualan
Keyword(s):  
Home Care ◽  
Hospital Discharge ◽  
Wound Dressing ◽  
Transitional Care ◽  
Teaching Method ◽  
Medication Administration ◽  
Instructional Materials ◽  
Burn Patients ◽  
Before And After ◽  
Burn Units

Abstract Introduction Unpreparedness of caregivers of burn patients can result to several complications at post-discharge period (Zwicker, 2010; AHRQ, 2012). Some burn centers in resource-scarce countries had documented several burn morbidity and mortality that occurred post hospital discharge. Psychological conditions, contractures, infection and even death are just some of the complications. One of the current trends in burns involves sending patients home with a burn dressing and following them up as outpatients for wound inspection. This could significantly reduce cost of hospitalization with shortened hospital stay and allows burn units to accommodate the overflow of acute and complex cases for admission. Although there are advantages in early discharge, this approach requires a change in the health teaching method and contents since hospital-to-home transition is expedited. Considering this dilemma, the investigator developed the CTCP to address the gap in transitional care of burns. This study aimed to compare the preparedness of caregivers before and after CTCP; and compare caregivers’ handwashing competency, wound dressing competency and medication administration hassle before and after CTCP. Methods One-group pre-and-posttest quasi-experimental design was used to study thirty adult caregivers of burn patients that were recruited via convenience sampling in a burn center between November 2017 to March 2018. CTCP was conducted in three sessions with the aid of videos and written instructional materials. Caregivers were evaluated in terms of preparedness (primary outcome) and handwashing competency, wound dressing competency and medication administration hassle (secondary outcomes). All measurement instruments were content valid and reliable. Results At alpha 0.05, data analysis revealed statistically significant results supporting the use of CTCP. Preparedness (p&lt; 0.001), handwashing competency (p&lt; 0.001), wound dressing competency (p&lt; 0.001) and medication administration hassle (p&lt; 0.001) improved after receiving the structured teaching intervention. Conclusions The study supported the relevance of the interventions to prepare caregivers for home care of burn patients to help prevent potential complications after hospital discharge. This is therefore recommended to be adapted by burn units that recognize primary caregivers as extended team members. Applicability of Research to Practice Since there is a limited evidence in nursing discharge education programs specific to burns, the results generated from this study can help practitioners effectively prepare caregivers for home care of burn patients as educational intervention is supported with strategies that increase learning retention.

scholarly journals Putting veterans with heart failure FIRST improves follow-up and reduces readmissions

2019 ◽  
Vol 8 (1) ◽  
pp. e000386 ◽  
Author(s):  
Serena Michelle Ogunwole ◽  
Jason Phillips ◽  
Amber Gossett ◽  
John Richard Downs
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Best Practices ◽  
Implementation Strategies ◽  
Quality Improvement Initiative ◽  
Medicine Department ◽  
High Risk Patients ◽  
Resource Limited ◽  
Risk Patients

BackgroundDespite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources.MethodsThis was a medical resident-driven initiative. A process map of the discharge and follow-up appointment process was created that identified multiple areas for improvement. Based on these findings, a two-part intervention was implemented. First, heart failure discharge education with focus on early follow-up was disseminated to providers throughout the internal medicine department. Subsequently, improved identification of high-risk patients (Failure Intervention Risk StratificationTool) and innovative use of the existing electronic medical record (EMR) were employed to sustain and improve on gains from the first set of interventions.ResultsWe increased our 7-day follow-up rate from 47% to 57% (p=0.429) and decreased the average time to follow-up from 17.6 days to 8.7 days (p=0.016) following the first intervention. The percentage of patients readmitted within 30 days after discharge at baseline (2012–2013) and following the first intervention (education and standardisation of follow-up scheduling) and second intervention (risk stratification, intensive follow-up and EMR change) was 25% and 21%, respectively. Thirty-day mortality rate decreased from 10% in 2011 to 7.16% in December 2015.ConclusionClose hospital discharge follow-up and identification of high-risk patients with CHF are useful approaches to reduce readmissions. Using the existing EMR tool for identifying high-risk patients and improving adherence to best practices is an effective intervention. In patients with CHF these strategies improved time to follow-up and 30-day readmissions while decreasing mortality.

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