Cardona Magnolia, Sav Adem, Michaleff Zoe A, Thomas Sarah T, Dobler Claudia C
Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia.
Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
Patient Prefer Adherence. 2023 Jan 20;17:153-165. doi: 10.2147/PPA.S385911. eCollection 2023.
To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors' perspective.
Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021-2022, with individual identification of priorities and voting on ranking.
Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients' but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors' solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits.
The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients' treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.
从患者和医生的角度识别并排序慢性心力衰竭（CHF）治疗负担的领域，包括在临床会诊期间应讨论的解决方案。
邀请了CHF患者和管理心力衰竭的临床医生。2021年至2022年以面对面或在线方式举行了名义小组技术会议，分别确定优先事项并进行排名投票。
共举行了四组患者会议（N = 22）和一组医生会议（N = 5）。对于心力衰竭患者，按优先顺序排列，医患沟通、医疗系统效率低下、医疗服务可及性问题、治疗费用影响、对患者及其家庭的心理社会影响以及治疗工作的影响是最重要的治疗负担。医生独立确定的优先事项与患者一致，但排名不同。患者提出的解决方案包括让护士或药剂师参与以增强对出院计划的理解，直至健康信息系统之间的联系，以及维持强大的家庭或社会支持网络。医生提出的解决方案包括使服药时间与日常生活活动相协调、对患者进行依从性重要性的教育、进行药物审查以克服临床惰性以及开展常规临床审计。
CHF患者最重要的治疗负担优先事项与与临床医生的互动及医疗系统效率低下有关，而医生通常了解患者的治疗负担，但倾向于关注直接治疗工作的复杂性。解决此处确定的优先问题可以从临床医生意识到对患者重要的问题并在临床会诊期间积极讨论可行的近期和长期解决方案开始。
