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.
J Cardiovasc Nurs. 2019 Sep/Oct;34(5):399-409. doi: 10.1097/JCN.0000000000000591.
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.
The aim of this study was to compare the barriers and facilitators of HF management as perceived by patients, significant others, and clinical providers.
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.
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.
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.
心力衰竭（HF）的管理需要患者、其重要他人和临床医生的共同参与。每个群体在 HF 管理方面可能面临独特或重叠的障碍。
本研究旨在比较患者、重要他人和临床医生对 HF 管理的障碍和促进因素的看法。
参与者是从退伍军人健康管理局的一个机构招募的。合格的患者有 HF（ICD9 代码 428.XX）的诊断，在过去一年中有 1 次或多次与 HF 相关的就诊，并且有一位主要照顾者是其重要他人。重要他人是没有认知障碍史的成年人，照顾 HF 患者。如果他们照顾 HF 患者，就有资格成为提供者。所有参与者都完成了半结构化访谈，旨在引出 HF 管理的障碍以及他们用来克服这些障碍的策略。访谈记录被转录并进行潜在主题分析，直到达到主题饱和。
共招募了 17 对夫妇和 12 名提供者。所有 3 组都认为沟通不良是 HF 管理的一个关键障碍，包括患者与其重要他人之间、夫妇与提供者之间以及提供者之间的沟通。重要他人指出，与临床医生缺乏直接沟通阻碍了他们照顾患者的努力。所有 3 组都强调了家庭成员在优化 HF 自我管理建议的遵守方面的重要性。
提供者、患者和重要他人在 HF 的管理中都扮演着重要而独特的角色。增强所有 3 者之间沟通和协作的工具以及支持重要他人的需求是当前 HF 护理缺失的组成部分。
