Clark Alexander M, Wiens Kelly S, Banner Davina, Kryworuchko Jennifer, Thirsk Lorraine, McLean Lianne, Currie Kay
Faculty of Nursing, Level 3 ECHA, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Nursing, University of Alberta, Edmonton, Canada.
Heart. 2016 May;102(9):707-11. doi: 10.1136/heartjnl-2015-308551. Epub 2016 Feb 23.
To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community.
Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care.
33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology.
Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use.
确定以医院、家庭或社区为基础的心力衰竭（HF）疾病管理项目的主要机制。
采用实在论综合法对定性和定量研究进行系统评价。检索策略纳入了与研究问题相关的一般和特定术语：HF、自我护理以及针对HF患者的项目/干预措施。要纳入研究，论文必须在1995年之后（由于近年来HF护理的变化）至2014年5月以英文发表，并且包含与HF项目效果机制相关的具体数据。检索了10个数据库；通过Proquest学位论文、谷歌以及专注于HF或自我护理的组织的出版物查找灰色文献。
共识别出33项研究（n = 3355名参与者，平均年龄：65岁，35%为女性）（18项随机对照试验、3项混合方法研究、6项前后测试研究和6项定性研究）。研究中确定的主要机制与患者对HF及其与自我护理联系的理解增加、其他人更多地参与这种自我护理、心理社会幸福感增强以及健康专业人员对使用技术的支持有关。
未来的HF疾病管理项目应寻求利用项目实际发挥作用以改善HF自我护理和结果的主要机制，而不是简单地复制其他项目的组成部分。最有希望利用的机制与提高患者理解和自我效能、其他护理人员和健康专业人员的参与以及改善心理社会幸福感和技术使用有关。
