Paper
Friday, July 15, 2005
Heart Failure Group Visit Clinic
Trisha J. Ofstad, RN, BSN, Cardiology Clinic, Naval Medical Center, San Diego, CA, USA and Denise M. Boren, PhD, RN, CNS, Nursing Research and Analysis Department, Naval Medical Center, San Diego, CA, USA.
Background: Nationwide, 5 million Americans suffer from heart failure with estimated costs of $25.8 billion spent annually for health care. Heart failure is the most frequent cause of hospitalization among older adults. Factors directly affecting hospital readmission are noncompliance with medication, poorly managed dietary regimen, failure to seek swift treatment, and failed social support systems. Group visits for chronically ill patients are shown to be effective in increasing access to care, and providing patients with education and support. The use of ACE inhibitors, beta-blockers and diuretic therapy are shown to improve outcomes. Objectives: (1) Examine the effect of group visits for heart failure patients; (2) measure outcomes of evidence-based guidelines for heart failure management; and (3) measure clinician adherence to evidence-based practices. Research Design and Methods: This project was guided by the Iowa Model of Evidence-Based Practice and the Diffusion of Innovations Model. A nurse run Heart Failure Clinic using a group visit approach was initiated. The educational focus, social support group, and treatment guidelines used in the clinic were research/evidence based. Baseline outcome measures for health partnership, quality of life, self-care management, depression and number of hospitalizations, plus measures of blood pressure, heart rate and BNP will be compared with the same measures at 6 months, 1 year and 18 months. Patient satisfaction is measured after 3 visits to the clinic. Adherence to evidenced-based practices is evaluated through record reviews. Findings: Participants are very satisfied with the Heart Failure Clinic, specifically with the multidisciplinary approach, educational focus and group visit format. Initial comparisons of outcome measures will be completed by February 2005. Conclusions: The nurse run Heart Failure Clinic using a group visit approach and evidence-based guidelines advanced nursing practice through research/evidence and is an excellent opportunity for collaboration among disciplines. Patients and families are very satisfied.