Elsevier

Heart & Lung

Volume 38, Issue 1, January–February 2009, Pages 25-33
Heart & Lung

Issues in cardiovascular nursing
The effect of shared medical visits on knowledge and self-care in patients with heart failure: A pilot study

https://doi.org/10.1016/j.hrtlng.2008.04.004Get rights and content

Objective

Patients with heart failure need education and support to improve knowledge and self-care. Shared medical groups that provide education and support have been successful in other patient populations. This study compares an advanced practice nurse-led shared medical appointment intervention in the office setting with standard care relative to self-care and knowledge among community-living adults with heart failure.

Methods

Participants were randomized to shared appointment and standard care groups, and completed the Heart Failure Knowledge Test and Self-Care Heart Failure Index at baseline and 8 weeks.

Results

From baseline to 8 weeks, Heart Failure Knowledge Test scores improved more for the intervention group than the control group (F time × group = 4.90, df = 1.21; P = .038). There was no difference in groups' rates of change on the total Self-Care Heart Failure Index.

Conclusion

The findings reveal improved knowledge when education and support are provided in a shared medical appointment setting. The shared medical visit model may be feasible as a way to provide patients with heart failure and their families with ongoing education and a supportive environment.

Section snippets

Research Questions

The research questions were as follows:

  • 1

    Is there a difference in knowledge about HF when comparing patients who participate in a shared medical appointment intervention with a control group who receive standard medical management?

  • 2

    Is there a difference in self-care behaviors when comparing patients who participate in a shared medical appointment intervention with a control group who receive standard medical management?

Materials and Methods

A longitudinal experimental research design was used for this study. Between July of 2005 and August of 2006, 52 adults with a diagnosis of HF and living in north central Indiana were enrolled in the study. Participants had either systolic or diastolic HF. Diagnosis was confirmed by documentation from the medical record. The population consisted of community-living adults with an established diagnosis of HF. Participants were excluded if there was cognitive impairment present or an inability to

Heart Failure Knowledge Test

The Heart Failure Knowledge Test (HFKT), created by Nancy Artinian, was used to measure knowledge.18 This tool was created to determine what patients know about “HF and the reason for symptoms; symptoms of worsening HF; low-sodium food selection; medications and actions to take if there are side effects; and self-management relative to weight monitoring, physical activity, and worsening symptoms” (p. 166).18 The tool has been tested for content validity.18 Internal consistency reliability was

Demographic characteristics

Fifty-two study participants were recruited over a 12-month period. Of these participants, 18 signed consents but did not participate in the study. Of these 18 participants who did not participate, 9 were randomly assigned to the intervention group and 9 were randomly assigned to the control group. Table I describes the demographics and comorbidities of all 34 participants who completed questionnaires at baseline. The longitudinal analysis of the HFKT included the 23 participants who completed

Discussion

Many previous studies on patients with HF focused on individual education, not group education.7, 13 Studies using the shared medical appointment model did not include patients with HF, making this pilot study the first to include patients with HF in this treatment model.8, 9, 10 This pilot study revealed that it is not only feasible to conduct shared medical appointments with patients with HF but also associated with an improvement in knowledge. A previous pilot study of shared medical

Limitations

The 2 major limitations of this study were the small sample size and the attrition of study participants. The timing of this study coincided with the departure of the lead interventional cardiologist. It took 2 months to recruit 10 participants and 10 months to recruit the remaining 42 participants after the cardiologist's departure. Patients receiving standard care continued to keep their appointments with the nurse practitioner, but they did not follow through with completing the

Conclusions and Implications

Future research using the shared medical visit model with the HF population needs to include larger sample sizes in multiple settings. Studies in which the medical shared visit classroom time is shortened from 60 to 30 minutes may decrease the time burden and possible fatigue. Measuring knowledge and self-care for 32 or 52 weeks may better measure a sustained change, in place of 8 weeks, which may be too brief to measure a sustained change.

There are many nurse-managed HF clinics. Incorporating

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