JMIR Publications

ABSTRACT

Background:

Currently 6.5 million Americans are living with HF. These patients are expected to follow complex self-management regimen at home. There are several demographic and psycho-social factors that limit HF patients in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Prior studies and systematic reviews demonstrated improvement in self-management and quality of life in HF with structured telephone support and mobile messaging.

Objective:

Evaluate self-care, knowledge, medication adherence, and quality of life of patients with heart failure (HF) after implementing structured telephone support (STS) and mobile messaging (MM).

Methods:

A prospective evidenced-based quality improvement project used a pre-post design. Data was collected at baseline, 30-days and 3-months on 51 patients with HF who were enrolled in the PACE program in Pinellas County, Florida. All participants received STS and MM for 30-days. Feasibility and sustained benefit of using STS and MM was assessed at 3-month follow-up

Results:

A paired t-test that compared the mean difference in HF outcomes at baseline and 30-day follow-up which demonstrated improved HF self-care maintenance (t=0.66; p=0.001), HF knowledge (t=0.71; p=0.001), medication adherence (t=0.92; p=0.001), physical and mental health measured by Short-Form 12 (t= 0.81; p=0.001). The results also demonstrated sustained benefit with improved HF self-care maintenance, self-care management, and self-care confidence, knowledge, medication adherence, physical and mental health (Short From-12) at 3-months with p value <0.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (less than 65 years of age) performed extremely well compared to older adults.

Conclusions:

STS and MM was feasible to use among PACE participants with sustained benefits at 3-months. Implementing STS and MM may serve as viable options to improve HF outcomes. Relevance to Clinical Practice: Improving outcomes with HF affects hospital systems as well as those agencies that monitor and provide care for outpatients and those in independent or assisted living facilities. Investigating viable options and support for implementation will improve outcomes. Clinical Trial: n/a