Self-care behaviors among patients with heart failure.
ABSTRACT One way to prevent frequent hospitalizations and promote positive health outcomes among patients with heart failure (HF) is to ensure that the amount and quality of self-care used is appropriate to the patient's situation.
The following are the purposes of this study: (a) examine the frequency of performance of self-care behaviors, (b) describe personal and environmental factors (basic conditioning factors [BCFs]) that affect self-care behaviors, and (c) describe the relationship between the level of knowledge patients have to empower their performance of self-care and the actual performance of self-care behaviors.
This descriptive correlational study was guided by Orem's theory of self-care. One hundred ten participants, predominantly African Americans, who were outpatients or inpatients ready for hospital discharge, 18 years or older, and diagnosed with HF that was confirmed by an ejection fraction of 40% or less were conveniently selected from 1 of 2 sites. Data were collected with 2 investigator-developed instruments: the Revised Heart Failure Self-Care Behavior Scale and the Heart Failure Knowledge Test. Descriptive statistics, correlational analyses, and t tests for independent samples were used to analyze the data.
Three of the top 5 most frequently performed self-care behaviors were related to taking prescribed medications, and the 5 least frequently performed self-care behaviors were concerned with symptom monitoring or management. There were no significant relationships between the total self-care behavior score and any of the BCFs; however, a number of significant relationships between BCFs and individual self-care behaviors were observed. There was a significant relationship between the mean total knowledge score and the total mean self-care score (r = 0.21, P =.026).
Detailed information about the influence of BCFs on the performance of specific HF self-care behaviors can help nurses tailor interventions to the patient's situation.
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Article: Sex differentials in health.[show abstract] [hide abstract]
ABSTRACT: Health status and health behavior of males and females in the United States are compared; the data employed in the analysis are from community studies and the surveys of the National Center for Health Statistics. Females generally show a higher incidence of acute conditions, higher prevalence of minor chronic conditions, more short-term restricted activity, and more use of health services (especially outpatient services) and medicines. By contrast, males have higher prevalence rates for life-threatening chronic conditions, higher incidence of injuries, more long-term disability, and after about age 50, higher rates of hospitalization. These sex differences appear at all ages, except for early childhood when boys have a worse health profile than girls. The following interpretations are consistent with the data; they are hypotheses rather than demonstrated facts. Women are more frequently ill than men, but with relatively mild problems. By contrast, men feel ill less often, but their illnesses and injuries are more serious. These morbidity differences help to explain sex differentials in health behavior; frequent symptoms lead to more restricted activity, physician and dentist visits, and drug use for women; severe symptoms lead to more permanent limitations and hospitalization for men. But attitudes about symptoms, medical care, drugs, and self-care are also extremely important. Males may be socialized to ignore physical discomforts; thus, they are unaware of symptoms that females feel keenly. Also, men may be less willing and able to seek medical care for perceived symptoms. When diagnosis and treatment are finally obtained, men's conditions are probably more advanced and less amenable to control. Finally, men may be less willing and able to restrict their activities when ill or injured. Four important factors than underlie sex differentials in health are discussed: inherited risks of illness, acquired risks of illness and injury, illness and prevention orientations, and health reporting behavior. Statistics show that women ultimately have lower mortality rates than men--despite women's more frequent morbidity and possibly because of more care for their illnesses and injuries. The apparent contradiction between sex differences in morbidity and mortality (females are sicker but males die sooner) is explored.Public Health Reports 97(5):417-37. · 1.42 Impact Factor
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ABSTRACT: Noncompliance with long-term medication regimens, such as those employed in the treatment of congestive heart failure (CHF), has been found to be approximately 50%. However, no evaluation has been performed on a population-based cohort of elderly patients beginning the use of digoxin and followed up longitudinally for an extended observation period. To study patterns of medication compliance, we conducted a retrospective follow-up of 7247 outpatients aged 65 to 99 years newly prescribed digoxin between 1981 and 1991, with the use of the complete prescription claims file of the New Jersey Medicaid program. Noncompliance was measured in terms of the number of days during the 12-month period after an initial digoxin prescription in which no CHF medication was available to the patient. Patients started on a regimen of digoxin were without digoxin or any other common alternative CHF drug for an average of 111 of the 365 days of follow-up. Only 10% of the population filled enough prescriptions to have daily CHF medication available for the entire year of follow-up. Compliance rates were higher in patients over 85 years of age, women, those taking multiple medications, and those with hospital or nursing home stays before the initiation of therapy. A large proportion of patients who begin digoxin therapy end CHF therapy or consume substantially less medication than expected in the first year of therapy. Such high rates of cessation could represent an important impediment to effective CHF therapy.Archives of Internal Medicine 03/1994; 154(4):433-7. · 11.46 Impact Factor
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ABSTRACT: To determine the feasibility and potential impact of a non-pharmacologic multidisciplinary intervention for reducing hospital readmissions in elderly patients with congestive heart failure. Prospective, randomized clinical trial, with 2:1 assignment to the study intervention or usual care. 550-bed secondary and tertiary care university teaching hospital. 98 patients > or = 70 years of age (mean 79 +/- 6 years) admitted with documented congestive heart failure. Comprehensive multidisciplinary treatment strategy consisting of intensive teaching by a geriatric cardiac nurse, a detailed review of medications by a geriatric cardiologist with specific recommendations designed to improve medication compliance and reduce side effects, early consultation with social services to facilitate discharge planning, dietary teaching by a hospital dietician, and close follow-up after discharge by home care and the study team. All patients were followed for 90 days after initial hospital discharge. The primary study endpoints were rehospitalization within the 90-day interval and the cumulative number of days hospitalized during follow-up. The 90-day readmission rate was 33.3% (21.7%-44.9%) for the patients receiving the study intervention (n = 63) compared with 45.7% (29.2%-62.2%) for the control patients (n = 35). The mean number of days hospitalized was 4.3 +/- 1.1 (2.1-6.5) for the treated patients vs 5.7 +/- 2.0 (1.8-9.6) for the usual-care patients. In a prospectively defined subgroup of patients at intermediate risk for readmission (n = 61), readmissions were reduced by 42.2% (from 47.6% to 27.5%; p = 0.10), and the average number of hospital days during follow-up decreased from 6.7 +/- 3.2 days to 3.2 +/- 1.2 days (p = NS). These pilot data suggest that a comprehensive, multidisciplinary approach to reducing repetitive hospitalizations in elderly patients with congestive heart failure may lead to a reduction in readmissions and hospital days, particularly in patients at moderate risk for early rehospitalization. Further evaluation of this treatment strategy, including an assessment of the cost-effectiveness, is warranted.Journal of General Internal Medicine 12/1993; 8(11):585-90. · 3.28 Impact Factor