Bekelman David B, Hooker Stephanie, Nowels Carolyn T, Main Deborah S, Meek Paula, McBryde Connor, Hattler Brack, Lorenz Karl A, Heidenreich Paul A
1 Eastern Colorado Health Care System , Department of Veterans Affairs, Denver, Colorado.
J Palliat Med. 2014 Feb;17(2):145-51. doi: 10.1089/jpm.2013.0143. Epub 2013 Dec 11.
People with chronic heart failure (HF) suffer from numerous symptoms that worsen quality of life. The CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) intervention was designed to improve symptoms and quality of life by integrating palliative and psychosocial care into chronic care.
Our aim was to determine the feasibility and acceptability of CASA and identify necessary improvements.
We conducted a prospective mixed-methods pilot trial. The CASA intervention included (1) nurse phone visits involving structured symptom assessments and guidelines to alleviate breathlessness, fatigue, pain, or depression; (2) structured phone counseling targeting adjustment to illness and depression if present; and (3) weekly team meetings with a palliative care specialist, cardiologist, and primary care physician focused on medical recommendations to primary care providers (PCPs, physician or nurse practioners) to improve symptoms. Study subjects were outpatients with chronic HF from a Veteran's Affairs hospital (n=15) and a university hospital (n=2). Measurements included feasibility (cohort retention rate, medical recommendation implementation rate, missing data, quality of care) and acceptability (an end-of-study semi-structured participant interview).
Participants were male with a median age of 63 years. One withdrew early and there were <5% missing data. Overall, 85% of 87 collaborative care team medical recommendations were implemented. All participants who screened positive for depression were either treated for depression or thought to not have a depressive disorder. In the qualitative interviews, patients reported a positive experience and provided several constructive critiques.
The CASA intervention was feasible based on participant enrollment, cohort retention, implementation of medical recommendations, minimal missing data, and acceptability. Several intervention changes were made based on participant feedback.
慢性心力衰竭（HF）患者会出现多种症状，这些症状会降低生活质量。CASA（缓解症状与适应疾病协作护理）干预措施旨在通过将姑息治疗和心理社会护理纳入慢性病护理来改善症状和生活质量。
我们的目的是确定CASA的可行性和可接受性，并确定必要的改进措施。
我们进行了一项前瞻性混合方法试点试验。CASA干预措施包括：（1）护士电话随访，包括结构化症状评估以及缓解呼吸急促、疲劳、疼痛或抑郁的指导方针；（2）针对适应疾病和抑郁（若存在）的结构化电话咨询；（3）每周与姑息治疗专家、心脏病专家和初级保健医生举行团队会议，重点是向初级保健提供者（PCP，医生或执业护士）提供医疗建议以改善症状。研究对象是来自一家退伍军人事务医院（n = 15）和一家大学医院（n = 2）的慢性HF门诊患者。测量指标包括可行性（队列保留率、医疗建议实施率、缺失数据、护理质量）和可接受性（研究结束时的半结构化参与者访谈）。
参与者均为男性，中位年龄为63岁。1人提前退出，缺失数据<5%。总体而言，87项协作护理团队医疗建议中有85%得到实施。所有抑郁筛查呈阳性的参与者均接受了抑郁症治疗或被认为没有抑郁症。在定性访谈中，患者报告了积极的体验并提出了一些建设性的批评意见。
基于参与者招募、队列保留、医疗建议的实施、极少的缺失数据和可接受性，CASA干预措施是可行的。根据参与者的反馈对干预措施进行了一些更改。
