Putting a stop to boomerang heart failure readmissions may require a sympathetic ear in the emergency department (ED). One pilot test has shown that it is possible to identify patients’ barriers to self-care, even in a busy ED setting.
Richard J. Holden, PhD, of the Center for Health Informatics Research and Innovation in Indianapolis, and colleagues evaluated the feasibility of using a “patient-centered, sociotechnical systems model” to better understand the factors that heart failure patients perceive as impeding their ability to take care of themselves. The study, whose results were published online Jan. 19 in the Annals of Emergency Medicine, was conducted in the ED at Vanderbilt University Medical Center in Nashville, Tenn.
The researchers recruited 31 patients with a primary diagnosis of acute heart failure or who were being treated for heart failure in the ED between June 2013 and January 2014. They assessed the use of an instrument that listed 47 items patients could say “often,” “sometimes” or “never” made self-care a challenge. Beyond that, the instrument offered three open-ended questions, including one that allowed patients to elaborate when they responded “often” or “sometimes.”
Patients self-reported a median of 15 barriers as “sometimes” or “often” present. More than a quarter of them reported 34 barriers and more than half listed nine barriers. The sources for the barriers ran the gamut, from the patient, the self-care task, tools, and organizational, social and physical contexts.
Administering the instrument took a median of 30 minutes, although it could last up to 90 minutes for patients who had many barriers or who offered detailed explanations. Patients who had trouble concentrating also required more time.
“Assessing self-care barriers in a setting such as the ED is achievable with an instrument that captures a range of relevant barriers, elicits enough information about each barrier to be able to address it appropriately, and can be completed without undue burden,” Holden et al wrote. “We believe the first step in addressing barriers is to develop a focused, valid, and feasible measurement instrument for self-care barriers in the ED.”
They acknowledged that using the instrument and developing strategies to eliminate the identified barriers required resources but the investment could be offset by the cost savings from reduced readmissions. They recommended testing the instrument in a broader patient population and in multiple EDs as well.