Peer Support--Congestive Heart Failure Self-Management

描述（由申请人提供）：充血性心力衰竭（CHF）的结果在很大程度上取决于患者对病情的有效自我管理。然而，慢性心力衰竭患者往往体弱多病、贫困和社会孤立，这些因素限制了他们管理自我保健和获得诊所服务的能力，导致可预防的住院治疗和不良结果。这项随机试验将评估一项为期六个月的干预措施，该干预措施包括与CHF护士管理人员进行小组访问，并结合低成本交互式语音应答（IVR）电话交换系统，该系统促进了点对点沟通，并促进了与护理管理人员的沟通。干预是基于小组访问和同伴支持对慢性疾病结局和自我护理行为的积极影响的研究，我们自己的研究显示了基于ivr的自我管理支持的有效性，以及一项成功的试点研究。具体目的是：1)评价团体访视+ ivr辅助同伴支持对CHF患者健康相关生活质量、生存率和再入院率的影响；2)评估干预对患者自我管理行为、指南一致性药物使用、感知社会支持、抑郁症状和护理满意度的影响；3)识别影响干预效果的中介因素；4)确定干预措施的增量成本效益。408名中度至高危CHF患者将在社区卫生保健系统中招募，该系统服务于大量少数种族和社会经济弱势CHF患者。我们将根据性别和疾病严重程度配对符合条件的患者。配对将随机分为：1)常规护理；或者2)常规护理与干预相结合。干预组的参与者将接受基于动机性访谈的同伴沟通技巧的简短培训，并参加由护理经理领导的初步互动小组访问。然后，他们将被要求使用IVR交换至少每周与他们的伴侣沟通一次。情侣们可以通过电话交谈，但不必透露他们的家庭电话号码，不必支付长途电话费，也不必承担确保定期与同伴联系的主要责任。IVR系统还将支持使用语音邮件的同伴之间的“异步”通信，以及参与者和护理经理之间的“异步”通信。在干预的第3个月和第6个月，参与者将被邀请参加小组访问，鼓励就CHF自我管理进行交流和讨论。研究人员将通过互联网监测这一过程，并在6个月和12个月时评估结果。该干预措施解决了慢性心力衰竭患者中常见的有效疾病管理的多重障碍。如果发现有效，这种方法可以用于改善患有其他慢性疾病的患者的健康状况，如抑郁症、慢性疼痛或糖尿病。

DESCRIPTION (provided by applicant): Congestive heart failure (CHF) outcomes depend critically on patients' effective self-management of their condition. Yet, patients with CHF are often frail, indigent, and socially isolated, factors that limit their ability to manage their self-care and access clinic-based services, leading to preventable hospitalizations and poor outcomes. This randomized trial will evaluate a six-month intervention that consists of group visits with CHF nurse managers in conjunction with a low-cost interactive voice response (IVR) telephone exchange system that promotes peer-to-peer communication and facilitates communication with care managers. The intervention is based on research on the positive impact of group visits and peer support on chronic disease outcomes and self-care behaviors, our own studies showing the effectiveness of IVR-based self-management supports, and a successful pilot study. The Specific Aims are:1)To evaluate the effect of group visits + IVR-facilitated peer support on CHF patients' health-related quality of life, survival, and rates of hospital readmission; 2) To assess the impact of the intervention on patients' self-management behaviors, use of guideline-concordant medications, perceived social support, depressive symptoms, and satisfaction with care; 3) To identify the mediating factors influencing the intervention's effectiveness; and 4) To determine the incremental cost-effectiveness of the intervention. 408 moderate to high-risk CHF patients will be recruited in a community health care system serving large numbers of racial minority and socioeconomically vulnerable CHF patients. We will pair eligible patients based on gender and illness severity. Pairs will be randomized to either: 1) usual care; or 2) usual care in conjunction with the intervention. Participants in the intervention arm will receive brief training in Motivational Interviewing-based peer communication techniques and participate in an initial care manager- led interactive group visit. They will then be asked to communicate at least weekly with their partner using the IVR exchange. Pairs will be able to talk by phone but without divulging their home phone number, incurring the cost of long distance calls, or having primary responsibility to ensure that the peer contacts occur regularly. The IVR system also will support "asynchronous" communication between peers using voicemail, as well as between participants and care managers. At months 3 and 6 of the intervention, participants will be invited to participate in group visits encouraging exchange and discussion on CHF self- management. Research staff will monitor the process via the Internet, and outcomes will be measured at six and 12-months. The intervention addresses multiple barriers to effective disease management common among CHF patients. If found effective, this approach could be used to improve health outcomes among patients with other chronic conditions, such as depression, chronic pain, or diabetes.