NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT

NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT

  Date: September 16, 2
Statement of PICO(T): In congestive heart failure patients (P), what effects does a multidisciplinary education approach (I) compared to the use of standard heart failure education (C) have on the rates of hospital readmissions (O) during the first six months of discharge? 

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Literature Review STUDY SUMMARIES
Author/title Purpose Framework Sample Design Variables/ instruments Results Similarities/Differences with other studies Limitations Implications for practice, research, theory
Dracup, K., Moser, D.K., & Pelter, M.M. (2014). A randomized controlled trial to improve self-care in patients with heart failure living in rural areas. NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT Dracup et al. (2014) aimed to determine the effect of education intervention on the composite endpoint of HF readmission and cardiac death. Conceptual

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N=602 Randomized clinical trail IVs: Participation or non-participation in Fluid Watchers LITE/Fluid Watchers PLUS.DVs: readmission rate, number of deaths in the studied population. Participation in Fluid Watchers/Fluid Watchers PLUS did not result in major improvements with regard to readmission rate/number of fatalities when compared to the control group. The study of Dracup et al. (2014) has a number of major differences from other studies that have been added to the matrix:(1) Unlike their colleagues, Dracup et al. (2014) divided study participants into three groups, which helped to examine the effects of more than one education intervention in the same study.

(2) Findings reported by Dracup et al. (2014) are different from the results that were introduced in other studies under analysis. According to Dracup et al. (2014), education intervention did not have any significant positive effect on the endpoint of HF readmission and cardiac death.

At the same time, the study of Dracup et al.(2014) is similar to the study of Kinugasa et al. (2014) examines rural HF patients. Results obtained by Dracup et al. (2014) are diametrically different from the findings of Kinugasa et al. (2014).

In any case, the findings of Dracup et al. (2014) are thought- provoking and encourage further research in the field.

Unique target population imposes restrictions on the generatability of findings.Face-to-face encounters – an integral part of the interventions investigated by Dracup et al.(2014) – are difficult to standardize.

Differences between the intervention groups might potentially bias the results.

HF patients living in rural areas of the country are at increased risk of readmission or mortality compared to patients in urban settings. Obviously, patients in rural areas could benefit from education intervention. However, the effect of such intervention is unclear, which raises questions about multidisciplinary collaboration.
Case management for patients with chronicsystolic heart failure in primary care: The HICMan

exploratory randomized controlled trial Authors:

Frank Peters-Klimm, Stephen Campbell, Katja Hermann, Cornelia U Kunz, Thomas Müller-Tasch,

Joachim Szecsenyi

Exploring the effectiveness of case management as a new model in the management of chronic systemic heart failure that is conducted by doctor’s assistants who have the same role as nurses with help from General Practitioners. Conceptual

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N=199 Randomized controlled trial Chronic heart failure self care , ,patient-reported quality of care,and quality of life.Continuous variables: age, gender, practice type The intervention failed to improve the overall generic anddisease-specific quality of life.

significant improvements in  the quality of Chronic heart failure

Showed low mortality rates with ~5% having lower rates of admissions to hospitals with significant increase in overall

practice attendances in the intervention group

The case management

intervention was found to be feasible

to conduct.

SimilaritiesScores of high quality life to reflect high level of chronic care and self care in patients with CHF. Presence of high evidenced-based pharmacotherapy

Differences

Medical care intensity and quality in terms of education and investigations

were higher in other studies

-variability in the complexity of case management in the intervention elements, education to patients and managers, integration of care sectors and empowerment of patients.

Neutral results found for longer (9 months to 1 year) follow up studies for the quality of life with positive effects

found in the

short term (3 to 6 months) follow-up

In patients with high risk of developing cardiovascular diseases, there is an improvement in the quality of life in

been found in primary care-based

interventions.

It was impossible to blind providers to treatment group, whicg could cause biasness to their way of treating the patients and the response of the patients to questionnaires. The randomizationwas performed at the patient level and all contamination between interventions occurred because the General practitioners received an orientation and counseling concerning the management of Chronic Heart Failure. The case management model shows an improvement in the quality of chronic heart failure self care which is important in the management of chronic heart failure in elderly and multi-morbid patients to achieve targeted outcomes.The study also creates avenue for the feasibility of the chronic care model in increasing the quality of life in patients. The study also creates avenue for the feasibility of the chronic care model in increasing the quality of life in patients.
Luttik, M.L., Jaarsma, T., van Geel, P.P., Brons, M., Hillege, H.L….& van Veldhuisen (2014). Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study.

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To determine whether long-term follow-up and treatment in primary care were as effective as follow-up at a specialized heart failure (HF) clinic with regard to guideline adherence and patient adherence (Luttik et al., 2014). Conceptual N=189 HF patients Multicenter, randomized, controlled study.

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IVs: type of treatment groupDVs: guidelines adherence, patient adherence, medication possession, number of deaths, hospital readmission rates. Participation in home-based HF and clinic-based HF did not have major differences in terms of guideline adherence, patient adherence, medication possession ratio, number of deaths and hospital readmission rate.However, the total number of non-CV hospital readmissions was higher in the primary care group than in the HV clinic group (Luttik et al., 2014). The main similarity is that Luttik et al. (2014) compare between the clinic-based HF and home-based HF, assuming that the latter setting offers more opportunities for a multidisciplinary education intervention. (1) Comparatively small number of patients.(2) Limited generasability of results due to the specific conditions that were relevant to the COACH-2 study.

(3) Study was conducted in the Netherlands; and its health system may be different from other countries as far as the applicability of findings is concerned.

Collaboration between experts is crucial to provide integrated care for HF patients.
Schou, M., Gustafsson, F., Videbaek, L., Tuxen, C., Keller, N…& Hildebrandt, P.R. (2013). Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (North Star)

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To examine the effect of an extended follow-up on HF in terms of an endpoint of a CV admission or death from any cause among stable systolic HF patients who were treated with optimal medical therapy (Schou et al., 2013). Conceptual N=921

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Multi-center, randomized, controlled trial IVs: type of intervention (either long-term follow-up in a specialized HF clinic or referral back to general practitioner).DVs: readmission or death from any cause among stable systolic HF participant. The study did not reveal any difference between the two groups with respect to primary endpoints of the follow-up (readmission rate or number of deaths).In high-risk patients, HFC follow-up was not associated with any benefits (Schou et al., 2013). Larger sample size distinguishes the study of Schou et al. (2013) from a number of other studies that are added to this matrix.Meanwhile, the research of Schou et al. (2013) is similar to the study of Luttik et al. (2014) examines the effects of COACH and other educational interventions on HF patients. The decision of Schou et al. (2013) to design their study as superiority and not as a non-inferiority trial might result in overlooking of 10-15% of patients to be safely referred to the GP; and this could be of potential clinical relevance.Open design of the trial could potentially bias the results.

Study was conducted in Denmark, and findings need verification before being generalized to other settings.

Low-risk patients do not benefit from long-term follow-up in specialized HF settings, which is the argument for integrated care, including multidisciplinary education.
Stewart, S., Carrington, M.J., Horowitz, J.D., Marwick, T.H., Netwon, P.J., Davidson, P.M., McDonald, P., Thompson, D.R., Chan, Y.K., Krum, H., Reid, C., & Scuffham, P.A. (2014). Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort. Stewart et al. (2014) compared two common forms of post-discharge management with an aim to assess the effect of patient education on recurrent hospitalization and survival in elderly patients.

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Conceptual N=280 Randomized controlled trial cohort IVs: clinic-based intervention and home-based intervention. The latter was associated with multidisciplinary education interventions, which makes the study relevant to this discussion.DVs: length of event-free survival and all cause- deaths.  Relative to event-free survival, there was no major difference between clinic-based and home-based interventions. However, home-based interventions were associated with fewer all-cause deaths (Stewart et al., 2014). It means that multidisciplinary education intervention that has become part of home-based intervention is effective in terms of reducing mortality among HF patients. The study of Stewart et al. (2014) is similar to the study of Valliant-Roussel et al. (2014) and the research of Dracup, Moser, and Pelter, (2014). The similarity lies in the fact that all the mentioned studies consider older people as their target group.At the same time, the study of Stewart et al. (2014) was conducted in Australian settings that are different from both French (Valliant-Roussel et al., 2014) and  American health realities (Dracup et al., 2014). Comparatively small sample size is considered the main limitation of the study.Also, it is worth admitting that the study was carried out in Australian health settings, which raises doubts about the generasability to findings in other settings. Overall, the study confirms the importance of multidisciplinary education intervention for reducing the number of all-cause deaths among elderly HF patients. However, the study does not suggest the form or content of such intervention.
Valliant-Roussel, H., Laporte, C., Pereira, B., Tanguy, G…&Vorilhon, P. (2014). Patient education on chronic heart failure in primary care (ETIC) and its impact on patient quality of life: design of a cluster randomized trial. To examine the effect of a complex intervention, involving patient and GP’s education, on a HF patient’s quality of life (QoL). Conceptual N=400

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Randomized, cluster controlled trial IVs: participation vs. non-participation in a 2-day GP workshop and patients’ education programme (Valliant-Roussel et al., 2014).DVs: HF patient’s quality of life (as determined in the Minnesota Living with Heart Failure Questionnaire and SF-36). Multidisciplinary patient education programs are more effective than standard heart failure education in terms of improving the quality of life in HF patients. The focus of the research that was carried out by Valliant et al. (2014) makes it different from other studies in the matrix. Unlike their colleagues, Valliant et al. (2014) consider a broader perspective to examine the effects of a multidisciplinary intervention. The study suggests that the effects of the intervention are not limited to morbidity or mortality, but they also include the patient’s emotional well-being, social integration and other major aspects of health. Number of HF patients was much less than the number of GPs taking part in the multidisciplinary education intervention (Valliant et al., 2014).Likewise, the number of GPs participating in the study may not be representative of French GPs. Multidisciplinary education interventions are effective with regard to improving secondary outcomes in HF patients; therefore, education initiatives should be an integral part of HF patients’ treatment. However, it is recommended to revise an approach that is adopted in France and a number of European countries. As specified by Valliant-Roussel et al. (2014), the discrepancy lies in the fact that while most multidisciplinary education interventions are aimed at younger people, the average age of HF patients is 61.4 years.

NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT References

Dracup, K., Moser, D.K., & Pelter, M.M. (2014). A randomized controlled trial to improve self-care in patients with heart failure living in rural areas. Circulation. 

Luttik, M.L., Jaarsma, T., van Geel, P.P., Brons, M., Hillege, H.L….& van Veldhuisen (2014). Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study. European Journal of Heart Failure, 16, 1241-1248. NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT.

Peters-Klimm, F., Campbell, S., Hermann, K., Kunz, C. U., Müller-Tasch, T., & Szecsenyi, J. (2010). Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial. Trials, 11(1). doi:10.1186/1745-6215-11-5

Schou, M., Gustafsson, F., Videbaek, L., Tuxen, C., Keller, N…& Hildebrandt, P.R. (2013). Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (North Star). European Heart Journal, 34(6), 432-442. NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT.

Stewart, S., Carrington, M.J., Horowitz, J.D., Marwick, T.H., Netwon, P.J., Davidson, P.M., McDonald, P., Thompson, D.R., Chan, Y.K., Krum, H., Reid, C., & Scuffham, P.A. (2014). Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort. Circulation, 133(19), 1867-1877.

Valliant-Roussel, H., Laporte, C., Pereira, B., Tanguy, G…&Vorilhon, P. (2014). Patient education in chronic heart failure in primary care (ETIC) and its impact on patient quality of life: design of a cluster randomized trial. BMC Family Practice, 15, 208. NURS 5220 LITERATURE REVIEW MATRIX ASSIGNMENT.