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Patient Preferences for the Delivery of Disease Management in Chronic Heart Failure: A Qualitative Study

Whitty, Jennifer A. PhD; Carrington, Melinda J. PhD; Stewart, Simon PhD; Holliday, Julie MHSc, BN; Marwick, Thomas H. MBBS, PhD, FRACP; Scuffham, Paul A. PhD

Journal of Cardiovascular Nursing: May/June 2012 - Volume 27 - Issue 3 - p 201–207
doi: 10.1097/JCN.0b013e31821abf22
Articles

Background and Research Objective: Chronic heart failure (CHF) management programs (CHF-MPs) are applied in different ways including via face-to-face settings. However, we know little about consumer preferences when applying CHF-MPs via a patient’s home or specialist hospital clinic. The aim of this pilot study was to explore CHF-MP characteristics that are considered desirable by patients with CHF.

Subject and Methods: Semistructured interviews with a purposive sample of 12 CHF patients.

Results: Participants had a mean age of 61 (SD, 17) years, 3 were female, and the majority was of white background. Most were assessed as either functional New York Heart Association class III (n = 3) or IV (n = 6). Home- and clinic-based CHF-MPs were preferred by 5 and 7 participants, respectively. Key themes around patient preferences related to practical aspects of program delivery and social and peer support, as well as health-related benefits that translate to traditional outcomes in program evaluations. Participants identified transport, cost, and ill health as barriers to attending a clinic-based program. However, they also highlighted benefits (eg, the ability to share experiences with other patients) that may be difficult to provide with a home-based service unless specifically organized.

Conclusions: These preliminary data suggest that patients value aspects of a program beyond those directly related to health outcomes. They also recognize a need for flexibility in program delivery, with potential preferences for home- or clinic-based programs depending largely on individual patient circumstances. More definitive studies are required to explore how best to cater for individual preferences while optimizing health outcomes.

Jennifer A. Whitty, PhD Senior Lecturer in Health Economics, Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, Australia.

Melinda J. Carrington, PhD General Manager, Disease Management & Preventative Programs, Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

Simon Stewart, PhD Head of Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

Julie Holliday, MHSc, BN Nurse Researcher, Cardiovascular Imaging Research Unit (CIRCUS), School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.

Thomas H. Marwick, MBBS, PhD, FRACP Professor of Medicine, Cardiovascular Imaging Research Unit (CIRCUS), School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.

Paul A. Scuffham, PhD Chair in Health Economics, Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, Australia.

Dr Whitty is supported by a research fellowship from the Queensland Government Department of Employment, Economic Development and Innovation, Queensland Health, and Griffith University.

This study (including personal support to Drs Carrington, Stewart, and Scuffham) was funded by a National Health and Medical Research Council of Australia health services research grant (418967) and program grant (519823).

The authors have no conflicts of interest to disclose.

Correspondence Jennifer A. Whitty, PhD, Centre for Applied Health Economics, School of Medicine, Logan Campus L03, Griffith University, University Dr, Meadowbrook, Queensland 4131, Australia (j.whitty@griffith.edu.au).

© 2012 Lippincott Williams & Wilkins, Inc.