A Family Partnership Intervention for Heart Failure

家庭合作干预心力衰竭

基本信息

批准号：
7849099
负责人：
SANDRA B. DUNBAR
金额：
$ 1.02万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-14 至 2009-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7849099
关键词：
Accident and Emergency department Accounting Activities of Daily Living Acute Adherence Age Alcohols Angiotensin-Converting Enzyme Inhibitors Beck depression inventory Behavior Body mass index Brain natriuretic peptide Cardiovascular system Caring Clinical Clinical Practice Guideline Clinical Research Comorbidity Complex Consumption Data Data Collection Diagnosis Diet Dietary Sodium Disease Diuretics Education Educational process of instructing Enrollment Evaluation Studies Event Exhibits Family Family Caregiver Family member Future Gender Guidelines Habits Health Health Resources Health Services Health behavior outcomes Healthcare Heart failure Hospitalization Hour Intake Intervention Left Ventricular Ejection Fraction Life Link Measures Minnesota Modeling Monitor Nurses Outcome Outpatients Patient Care Patients Pattern Perceived quality of life Performance Persons Pharmaceutical Preparations Physical activity Plasma Population Heterogeneity Process Provider Quality of life Questionnaires Randomized Reporting Research Sampling Schedule Self Care Self Management Severities Smoke Sodium Structure System Testing Time Treatment Protocols United States Visit Walking Work base clinical practice cost depressive symptoms design family influence health related quality of life high risk hospital readmission ilium improved intervention effect medication compliance novel strategies primary outcome programs psychologic psychological outcomes symptom management theories treatment as usual urinary

项目摘要

DESCRIPTION (provided by applicant): Self-management behaviors required for persons with heart failure (HF) are multifaceted and include initiating and maintaining a reduced sodium diet and implementing a complex medication regimen. Adherence to these behaviors is poor, and nonadherence accounts for a large percentage of HF hospital readmissions and health services use. Because performance of these behaviors occurs in the family context and is influenced by family activities and habits, a family approach to improve self-management behaviors has great promise. This study will evaluate the incremental effect of a family-focused intervention over a structured patient-family education program and usual care for persons with heart failure. The study will examine whether adding a family partnership intervention (FPI) based on autonomy support theory improves dietary and medication-taking self-management behaviors over a structured patient family education program or usual care. A randomized three group repeated measures design will be used to enroll HF patient-family member dyads (n=262). The FPI Intervention will be delivered in the outpatient setting in a group format, and patient-family education and data collection will occur in the General Clinical Research Center. Patient variables and measures are dietary sodium (24-hour urinary sodium), medication adherence to HF drugs including angiotensin converting enzyme inhibitors and diuretics (Medication Event Monitoring System), heart failure severity (brain natriuretic peptide levels), functional ability (6 minute walk distance), HF patient depressive symptoms (Beck Depression Inventory II), and perceived quality of life (Minnesota Living with Heart Failure Questionnaire). Data will be obtained at baseline, and 4 and 8 months. Family member variables include depressive symptoms (Beck Depression Inventory-II) obtained at baseline, 4 and 8 months. Secondary aims will examine health resource utilization (hospitalizations, emergency department or provider contacts) over the 8 months and patient and family member perceived autonomy support. Baseline measures of clinical (NYHA Class, left ventricular ejection fraction, comorbidities), sociodemographic, and general family functioning variables will be obtained for sample description and use as covariates in hypothesis testing. Repeated measures models will be used to test the hypotheses of group differences in adherence and quality of life, physical and psychological outcomes over time controlling for pertinent clinical and sociodemographic variables. This study will test whether a cost-effective, theoretically-based, nurse managed autonomy support intervention provides an incremental effect over structured patient-family teaching and usual care in improving patient and family outcomes. This study will provide data upon which future clinical practice guidelines can be based and will establish priorities for patient care according to which interventions are linked to improved self-management behaviors. Greater understanding of the relationships among family functioning, self management behaviors, psychological and physical outcomes, and health resource utilization are important for future studies and evaluation of clinical practice with HF patients.

描述（由申请人提供）：心力衰竭（HF）所需的自我管理行为是多方面的，包括启动和维持减少钠饮食并实施复杂的药物治疗方案。遵守这些行为很差，不遵守占HF医院再入院和健康服务使用的很大比例。因为这些行为的表现发生在家庭环境中，并且受家庭活动和习惯的影响，因此一种改善自我管理行为的家庭方法有很大的希望。这项研究将评估以家庭为重点的干预措施对结构化患者教育计划的增量效应，并为患有心力衰竭的患者进行常规护理。该研究将研究基于自主支持理论的家庭伙伴关系干预（FPI）是否改善了对结构化患者家庭教育计划或常规护理的饮食和服药自我管理行为。随机三组重复措施设计将用于招募HF患者家庭成员二元组（n = 262）。 FPI干预措施将在门诊环境中以小组格式进行，并将在一般临床研究中心进行患者家庭教育和数据收集。患者的变量和措施是饮食中钠（24小时尿钠），对HF药物的依从性，包括血管紧张素转化酶抑制剂和利尿剂（药物监测系统），心力衰竭严重程度，脑力衰竭水平（脑鼻尿液肽水平），功能性抑郁症（6分钟），II II（HF），II II型（BEC），良性抑郁症（BEC）（明尼苏达州与心力衰竭问卷生活在一起）。数据将在基线和4个月和8个月时获得。家庭成员变量包括在基线4和8个月获得的抑郁症状（贝克抑郁量表II）。次要目的将在8个月内检查健康资源利用（住院，急诊室或提供者联系），并认为患者和家人认为自治。将获得临床（NYHA类，左心室射血分数，合并症），社会人口统计学和一般家庭功能变量的基线测量，以用于样本描述并用作假设测试中的协变量。重复测量模型将用于测试遵循生活和心理质量，身体和心理结果的群体差异的假设，以控制相关的临床和社会人口统计学变量。这项研究将测试一个具有成本效益的基于理论上的，护士管理的自主支持干预措施是否对结构化患者教学和在改善患者和家庭成果改善的结构化患者教学和通常的护理产生了渐进效果。这项研究将提供有关未来临床实践指南可以基于的数据，并根据患者护理的优先级，根据哪些干预措施与改善的自我管理行为有关。对家庭功能，自我管理行为，心理和身体成果以及健康资源利用之间的关系的更多了解对于未来的研究和对HF患者的临床实践评估很重要。