Jose Prinu, Ravindranath Ranjana, Joseph Linju M, Rhodes Elizabeth C, Ganapathi Sanjay, Harikrishnan Sivadasanpillai, Jeemon Panniyammakal
Public Health Foundation of India, New Delhi, India.
Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India.
Wellcome Open Res. 2021 Apr 19;5:250. doi: 10.12688/wellcomeopenres.16365.2. eCollection 2020.
Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Patients' motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients' health status were important enablers of high-quality care. Health care providers' advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients' self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.
心力衰竭（HF）患者护理质量的缺陷导致了该人群的高死亡率。这项定性研究旨在了解印度喀拉拉邦高质量HF护理的障碍和促进因素。对医疗服务提供者（n = 13）、患者及其护理人员（n = 14）进行了有目的抽样的半结构化深度访谈。此外，还与患者及其护理人员进行了焦点小组讨论（n = 3）。所有访谈和焦点小组讨论都逐字记录。使用主题分析法对文本数据进行分析。HF诊断后患者改变生活方式行为的动机以及医疗服务提供者主动进行随访电话以检查患者健康状况是高质量护理的重要促成因素。医疗服务提供者关于物质使用的建议常常促使患者戒烟和戒酒。尽管患者期望得到家人的支持，但护理人员对患者的支持程度各不相同，一些患者得到护理人员的大力支持，而另一些患者得到的支持很少。情绪压力和缺乏针对患者的结构化护理计划阻碍了患者对自身病情的自我管理。此外，高患者负荷常常限制了医疗服务提供者提供自我管理选择建议的时间。然而，有经验的护理人员的可获得性改善了医疗机构内的护理。最后，由于HF患者存在多种并存的慢性病，医疗服务提供者认为启动指南指导的药物治疗很复杂。HF自我管理的结构化计划以及患者和医疗服务提供者在临床就诊时有更多时间互动，可能有助于与患者及其家人进行更好的临床交接，从而提高对自我护理选择的依从性。质量改进干预措施还应解决HF患者的压力和情绪问题。
