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08-11-2011 | Cardiology | Article

Person-centered care has benefits for heart failure patients

Abstract

Free abstract

MedWire News: A person-centered approach to care for patients with chronic heart failure leads to a reduced length of hospital stay without worse patient functioning or increased chances of readmission, show Swedish study results.

Patients who are actively involved in and receive regular follow-up care in a coordinated system report better activities of daily living (ADL; indicating patient functioning), and greater satisfaction with care, say the researchers.

"This suggests that partnerships between patients and healthcare professionals in CHF management could improve outcomes," write Axel Wolf (Sahlgrenska Academy, University of Gothenburg) and colleagues in the European Heart Journal.

The team therefore compared person-centered care (PCC) and usual care among 248 patients with heart failure to evaluate whether length of stay, health-related quality of life, and hospital readmission could be reduced using the former protocol.

A total of 125 patients were randomly assigned to the PCC group, which involved physicians obtaining a comprehensive narrative from the patient at admission (symptoms, motivations, ADL), encouraging patients to be as active as possible and promoting shared decision-making, and safeguarding the relationship by documenting all assessments.

While all patients' baseline characteristics, including age, gender, comorbidities, and ADL functions were similar, those in the PCC group were significantly more symptomatic than those in the usual care group.

Length of stay was a mean 9.2 days in the PCC group compared with 8.2 days in the usual care group, report Wolf et al.

Indeed, after a per-protocol analysis (excluding PCC patients without prompt PCC assessment after admission and sufficient protocol follow-up), the researchers found that length of stay was significantly shorter in the PCC than the usual care group, at a difference of 2.5 days.

Physical functioning, measured using the Katz-ADL index, was similar at baseline between the two groups, whereas at discharge from hospital ADL levels were significantly better in the PCC group.

Of note, time to first readmission did not differ significantly between the two patient groups; readmission occurred within 6 months of discharge in 49% of PCC patients and 59% of usual care patients.

Speaking in a press statement, co-author and director of the Sahlgrenska Academy, Inger Ekman, explained that even though PCC-treated patients received "effective and high-quality healthcare," just 60% of that care was consistent during the 2009-2010 study period.

"[This] shows the difficulty of rearranging the healthcare culture since it is based on a person with an illness and not on the person's illness alone. The biggest challenge will be to break the traditional and rigid structure of healthcare," he added.

The research team plan to undertake a similar study in patients with acute coronary syndrome.

By Sarah Guy

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