Breathett Khadijah, D'Amico Rachel, Adesanya T M Ayodele, Hatfield Stefanie, Willis Shannon, Sturdivant Rodney X, Foraker Randi E, Smith Sakima, Binkley Philip, Abraham William T, Peterson Pamela N
From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.).
Circ Heart Fail. 2017 Jun;10(6). doi: 10.1161/CIRCHEARTFAILURE.117.004099.
Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post-HF hospitalization have not been extensively evaluated.
Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African American, 34% Caucasian, and 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post-HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed-rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35 000 for 49% of patients. An appointment near the patient's home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of copayment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of copay (46%), and transportation to appointment (39%). There were significant differences (=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared with low-ranking interventions related to time (weekend appointment, appointment after 5 pm) and telemedicine.
Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient's home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.
建议对心力衰竭(HF)患者出院后进行及时随访。然而,随访情况并不理想,尤其是在社会经济地位较低的群体中。以患者为中心的促进HF住院后随访的解决方案尚未得到广泛评估。
2015年至2016年间,对俄亥俄州哥伦布市低收入地区一家大学医院收治的83名不同种族的成年HF患者(61%为非裔美国人,34%为白种人,5%为其他种族)进行了面对面调查。使用李克特量表(1 = 非常愿意到5 = 完全不愿意)调查患者对促进HF住院后随访方法的看法以及使用干预措施的可能性。结果采用Wilcoxon符号秩检验并进行Bonferroni校正分析。回复率为82%。49%的患者家庭年收入低于35,000美元。最希望得到的干预措施是在患者家附近安排预约(77%),其次是提醒信息(73%)、前往预约地点的交通服务(63%)和免除自付费用(59%)。如果提供这些干预措施,最有可能使用的干预措施排名类似:提醒信息(48%)、在患者家附近预约(46%)、免除自付费用(46%)和前往预约地点的交通服务(39%)。与与时间相关的低排名干预措施(周末预约、下午5点之后的预约)和远程医疗相比,与地点相关的高排名干预措施(在患者家附近预约、交通服务、上门预约)和就诊提醒存在显著差异(P = 0.001)。
在这一不同种族的低收入HF住院患者队列中,在患者家附近安排预约和提醒信息是促进随访最希望得到的干预措施。有必要在全国范围内对类似人群进行进一步研究。