Emory University, Nell Hodgson Woodruff School of Nursing, Georgia, Atlanta, USA.
Merck & Co., Inc., New Jersey, Rahway, USA.
J Adv Nurs. 2023 Sep;79(9):3535-3548. doi: 10.1111/jan.15682. Epub 2023 May 2.
To explore the associations between social determinants of health and patient-centred outcomes among adults with chronic heart failure with reduced ejection fraction.
Cross-sectional online self-report survey.
A survey assessing social determinants of health (demographics, socio-economic position, affordability of care and social support) and patient-centred outcomes, including the Kansas City Cardiomyopathy Questionnaire-12 and validated measures of medication adherence, treatment satisfaction, treatment burden and mental health, was completed by 512 adults with chronic heart failure with a reduced ejection fraction between 06 March and 29 June 2020. Multivariable analyses included linear and logistic regression.
Female gender, having a care partner, and being offered financial assistance with medications were associated with worse health status, while perceiving medication as affordable and being married were associated with better health status. Females and having Medicaid, dual Medicaid/Medicare or no medical insurance were associated with a higher likelihood of depression, and non-white race/ethnicity was associated with less depression. Medication adherence was lower in patients having a care partner and offered financial assistance. Patients being offered financial and medication management assistance were more likely to be overwhelmed by the treatment burden, whereas those having some college education were less so.
Social determinants of health are associated with patients' disease-specific health status, mental health and treatment satisfaction and burden. These findings underscore the importance of assessing social determinants of health in clinical practice and the need for developing and testing novel strategies to determine whether they improve patients' health.
The relationship between social determinants of health- and patient-centred outcomes was assessed; affordability of care and social support factors were most strongly associated with outcomes for patients with chronic heart failure and reduced ejection fraction, underscoring the importance of assessing social determinants of health in routine clinical care.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Social determinants of health data could potentially inform care delivery for patients with heart failure and reduced ejection fraction by helping to identify those who require additional support to manage their symptoms, access care and adhere to treatment. Social support and affordability of treatment were associated with most patient-centred outcomes, suggesting these factors may provide clinicians with an indicator of a patient's level of general well-being that could be assessed during routine follow-up care.
This research followed the STROBE checklist for cross-sectional studies.
Adults who have heart failure with reduced ejection fraction that consented to participate in the study provided the data used for all analyses reported on in the manuscript. Service users, caregivers or members of the public had no involvement in the study.
探讨社会决定因素与射血分数降低的慢性心力衰竭患者的以患者为中心的结局之间的关系。
横断面在线自我报告调查。
一项评估社会决定因素（人口统计学、社会经济地位、医疗保健负担能力和社会支持）和以患者为中心的结局（包括堪萨斯城心肌病问卷-12 和经过验证的药物依从性、治疗满意度、治疗负担和心理健康测量）的调查，由 512 名射血分数降低的慢性心力衰竭成年患者于 2020 年 3 月 6 日至 6 月 29 日之间在线完成。多变量分析包括线性和逻辑回归。
女性、有照顾者和获得药物经济援助与较差的健康状况相关，而认为药物负担得起和已婚与更好的健康状况相关。女性和拥有医疗补助、医疗补助/医疗保险双重保险或没有医疗保险与更高的抑郁风险相关，非白人和少数民族与更低的抑郁风险相关。有照顾者和获得经济援助的患者药物依从性较低。获得经济和药物管理援助的患者更有可能因治疗负担过重而感到不知所措，而那些接受过一些大学教育的患者则不然。
社会决定因素与患者的特定疾病健康状况、心理健康和治疗满意度和负担相关。这些发现强调了在临床实践中评估社会决定因素的重要性，以及需要制定和测试新策略来确定它们是否能改善患者的健康。
评估了社会决定因素与以患者为中心的结局之间的关系；医疗保健负担能力和社会支持因素与射血分数降低的慢性心力衰竭患者的结局关系最密切，这突显了在常规临床护理中评估社会决定因素的重要性。
对专业人员和/或患者护理的影响：社会决定因素的数据可能通过帮助识别那些需要额外支持来管理症状、获得医疗保健和遵守治疗的患者，从而为心力衰竭和射血分数降低的患者的护理提供信息。社会支持和治疗负担能力与大多数以患者为中心的结局相关，这表明这些因素可能为临床医生提供患者整体健康水平的指标，可以在常规随访护理期间进行评估。
本研究遵循 STROBE 检查表进行横断面研究。
同意参加研究的射血分数降低的慢性心力衰竭成人提供了报告的所有分析中使用的数据。服务使用者、护理人员或公众没有参与研究。
