Self-Management of Early Stage Heart Failure

早期心力衰竭的自我管理

• 批准号: 6831438
• 负责人: Stephenie C. Lemon
• 金额: $ 10万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6831438
• 关键词: behavioral /social science research tag; cardiovascular disorder prevention; cardiovascular disorder therapy; clinical research; cognitive behavior therapy; counseling; goal oriented behavior; health behavior; health services research tag; health surveys; heart failure; human subject; human therapy evaluation; nursing intervention; outcomes research; patient care management; patient oriented research; self care; telemedicine; therapy compliance; therapy design /development

DESCRIPTION (PROVIDED BY APPLICANT: Heart failure (HF) is a significant public health problem in the United States, particularly among the elderly. Adherence to evidence-based treatment and management guidelines requires continual compliance with multiple proven pharmacologic and behavioral regimens, which can be challenging. HF is a progressive disease, and appropriate management at early stages could improve health outcomes. Intervention studies to date, however, have largely focused on persons with moderate and advanced disease. To improve secondary prevention among early stage patients and decrease disease progression, effective strategies need to be developed to improve evidence-based practice and guideline adherence in real world settings. Early stage HF, however, poses research challenges because it can be difficult to diagnose, difficult to motivate patients who are mildly symptomatic to change multiple behaviors, and because patients are largely monitored through overburdened primary care systems. Tailored intervention protocols need to be developed and pilot tested. We propose to pilot test a patient-centered, nurse practitioner-delivered intervention, developed under the framework of the Chronic Care Model, targeting early stage HF patients managed within primary care settings. The pilot will be conducted at a large academic medical center and a community affiliated practice site. The tailored intervention uses a patient-centered counseling approach, largely informed by Social Cognitive Theory, which consists of: 1) an in-person Self-Management Planning Session (SMPS) with a Nurse Practitioner (NP), and 2) five Telephone Reinforcement Sessions (TRS) with the NP. The purpose of the SMPS is to engage the patient in an interactive session with the NP which includes HF education, the identification of individual self-management needs, the identification of barriers to appropriate self-management, and the development of self-management goals and an action plan to address barriers. TRS will be tailored, based on the needs, barriers, goals and action plan identified in the SMPS and are intended to assess progress, re-evaluate goals and make additional goals and plans as necessary. Central to the intervention is the inclusion of a well-formulated, systematic communication process between the NP and the PCP. The intervention will be pilot tested on 20 early stage HF patients. A well designed process evaluation plan has been designed to assess the feasibility of implementing a subsequent effectiveness trial, assess patient receptivity to the strategy, assess PCP receptivity to the strategy and utility of the NP communication system, and test and refine measurement tools. Upon completion, the intervention strategy will be refined for the purpose of testing its effectiveness in a randomized controlled trial.

描述（申请人提供）：心力衰竭（HF）是美国的一个重大公共卫生问题，尤其是在老年人中。坚持循证治疗和管理指南需要持续遵守多种经证实的药理学和行为方案，这可能具有挑战性。HF是一种进行性疾病，在早期阶段进行适当的管理可以改善健康结果。然而，迄今为止的干预研究主要集中在中度和晚期疾病患者身上。为了改善早期患者的二级预防并减少疾病进展，需要制定有效的策略来改善循证实践和真实的世界环境中的指南依从性。 然而，早期HF给研究带来了挑战，因为它可能难以诊断，难以激励症状轻微的患者改变多种行为，并且因为患者在很大程度上通过负担过重的初级保健系统进行监测。需要制定和试点测试有针对性的干预方案。我们建议对在慢性病护理模式框架下开发的以患者为中心的护士干预措施进行试点测试，目标是在初级保健环境中管理的早期HF患者。试点将在一个大型学术医疗中心和一个社区附属实践场所进行。量身定制的干预使用以患者为中心的咨询方法，主要由社会认知理论提供信息，包括：1）与执业护士（NP）进行的面对面自我管理计划会议（SMPS），以及2）与NP进行的五次电话强化会议（TRS）。SMPS的目的是让患者参与与NP的互动会话，其中包括HF教育，识别个人自我管理需求，识别适当自我管理的障碍，以及制定自我管理目标和解决障碍的行动计划。TRS将根据SMPS中确定的需求、障碍、目标和行动计划进行定制，旨在评估进展情况，重新评估目标，并在必要时制定额外的目标和计划。干预的核心是在国家警察和初级警察之间纳入一个精心制定的系统性沟通过程。该干预措施将在20名早期HF患者中进行试点测试。设计了一个精心设计的过程评价计划，以评估实施后续有效性试验的可行性，评估患者对该策略的接受程度，评估PCP对NP沟通系统的策略和效用的接受程度，并测试和完善测量工具。完成后，将对干预策略进行改进，以便在随机对照试验中测试其有效性。