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Comparing the Barriers and Facilitators of Heart Failure Management as Perceived by Patients, Caregivers, and Clinical Providers

Trivedi, Ranak B. PhD; Slightam, Cindie MPH; Nevedal, Andrea PhD; Guetterman, Timothy C. PhD; Fan, Vincent S. MD, MPH; Nelson, Karin M. MD, MS; Rosland, Ann-Marie MD; Heidenreich, Paul A. MD; Timko, Christine PhD; Asch, Steven M. MD, MPH; Piette, John D. PhD

doi: 10.1097/JCN.0000000000000591
ARTICLES: Heart Failure
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Background: Heart failure (HF) management requires the participation of patients, their significant others, and clinical providers. Each group may face barriers to HF management that may be unique or may overlap.

Objective: The aim of this study was to compare the barriers and facilitators of HF management as perceived by patients, significant others, and clinical providers.

Methods: Participants were recruited from a Veterans Health Administration facility. Eligible patients had a diagnosis of HF (ICD9 code 428.XX), 1 or more HF-related visit in the previous year, and a significant other who was their primary caregiver. Significant others were adults with no history of cognitive impairments caring for patients with HF. Providers were eligible if they cared for patients with HF. All participants completed semistructured interviews designed to elicit barriers to managing HF and strategies that they used to overcome these barriers. Interviews were transcribed and analyzed using latent thematic analysis, and recruitment continued until thematic saturation was attained.

Results: A total of 17 couples and 12 providers were recruited. All 3 groups identified poor communication as a key barrier to HF management, including communication between patients and their significant other, between couples and providers, and providers with each other. Significant others noted that the lack of direct communication with clinical providers hindered their efforts to care for the patient. All 3 groups emphasized the importance of family members in optimizing adherence to HF self-management recommendations.

Conclusions: Providers, patients, and significant others all play important and distinct roles in the management of HF. Tools to enhance communication and collaboration for all 3 and supporting the needs of significant others are missing components of current HF care.

Ranak B. Trivedi, PhD Core Investigator, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto; and Assistant Professor, Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, California.

Cindie Slightam, MPH Research Health Science Specialist, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California.

Andrea Nevedal, PhD Core Investigator, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California.

Timothy C. Guetterman, PhD Assistant Professor, Department of Family Medicine, University of Michigan, Ann Arbor.

Vincent S. Fan, MD, MPH Core Investigator, Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington; and Associate Professor, Department of Medicine, University of Washington, Seattle.

Karin M. Nelson, MD, MSHS Core Investigator, Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington; and Professor, Department of Medicine, University of Washington, Seattle.

Ann-Marie Rosland, MD Core Investigator, Center for Health Equity, VA Pittsburgh Health Care System; and Associate Professor, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania.

Paul A. Heidenreich, MD Core Investigator, Center for Innovation to Implementation, VA Palo Alto Health Care System; and Professor, Division of Cardiology, Stanford University School of Medicine, California.

Christine Timko, PhD Research Career Scientist, Center for Innovation to Implementation, VA Palo Alto Health Care System, California.

Steven M. Asch, MD, MPH Director, Center for Innovation to Implementation, VA Palo Alto Health Care System; and Professor, Division of General Internal Medicine, Stanford University School of Medicine, California.

John D. Piette, PhD Senior Research Career Scientist, Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, Michigan; and Director, Center for Managing Chronic Disease, School of Public Health, University of Michigan, Ann Arbor.

This study was supported by funding from the VA Chronic Heart Failure QUERI. Drs Trivedi and Rosland were supported by VA HSR&D Career Development Awards. Drs Piette and Timko were supported by VA HSR&D Senior Research Career Scientist Awards.

All views expressed herein are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs.

The authors do not have conflicts of interest to disclose.

Correspondence Ranak B. Trivedi, PhD, 795 Willow Rd (MPD-152), Center for Innovation to Implementation, Bldg 324, B-134, Menlo Park, CA 94025 (ranakt@stanford.edu).

Online date: July 31, 2019

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