A Description of Patient and Provider Experience and Clinical Outcomes After Heart Failure Shared Medical Appointment.
A Description of Patient and Provider Experience and Clinical Outcomes After Heart Failure Shared Medical Appointment.
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DOI：
10.1177/2374373517714452
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发表时间：
2017-12
影响因子：
1.5
通讯作者：
Wu WC
中科院分区：
文献类型：
--
作者：
Cohen LB;Parent M;Taveira TH;Dev S;Wu WC
共享医疗预约（SMA）是指多名患者同时与1名或多名提供者会面的临床访问。描述最近因心力衰竭（HF）出院的退伍军人的跨学科SMA结局。回顾性图表回顾患者的再入院率、生存率、药物依从性和药物相关问题。对于定性结果，我们对12例接受HF SMA的患者及其各自的护理人员进行了半结构化访谈，重点关注护理满意度、HF知识、疾病自我护理、药物协调和同伴支持。该队列包括70名患者-49%的左心室功能<40% and 50% were prescribed >10种药物。60%的患者发生了与药物相关的问题。访谈显示对HF-SMA的总体满意度，但患者对HF指导感到不知所措，认为缺乏同伴支持和自我效能感，以及与HF相关的绝望感。共享医疗预约是很好的感知。药物治疗问题和药物治疗管理的需求沿着患者在HF护理中缺乏自我效能。可能需要多次HF-SMA访视，以强化概念，减少混淆，并获得同行支持。
Shared medical appointments (SMAs) are clinical visits in which several patients meet with 1 or more providers at the same time. To describe the outcomes of an interdisciplinary SMA for veterans recently discharged for heart failure (HF). A retrospective chart review for patients’ readmission rates, survival, medication adherence, and medication-related problems. For qualitative outcomes, we performed semistructured interviews on 12 patients who had undergone HF SMAs and their respective caregivers focusing on care satisfaction, HF knowledge, disease self-care, medication reconciliation, and peer support. The cohort comprised 70 patients—49% had left ventricular function <40% and 50% were prescribed >10 medications. Medication-related problems occurred in 60% of patients. Interviews revealed overall satisfaction with HF-SMA, but patients felt overwhelmed with HF instructions, perceived lack of peer support and self-efficacy, and feelings of hopelessness related to HF. Shared medical appointments are well-perceived. Medication problems and need for medication management are prevalent along with patient’s lack of self-efficacy in HF care. Multiple HF-SMA visits may be needed to reinforce concepts, reduce confusion, and garner peer support.