October 9, 2013
Team Including Pharmacists Improves Care, Quality of Life
for Heart Failure Patients
Orlando, FL—Pharmacists, working in teams with nurses and physicians, can be a critical factor in improving both care and quality of life for patients with heart failure (HF), according to two new studies.
The studies were presented recently at the Heart Failure Society of America meeting in Orlando, Florida. One presentation, from University of California Davis researchers, discussed the important role the team played in improving access to care, reducing hospital admissions, and teaching self-care to patients with HF. The other, delivered by a researcher from the University of Florida and the Veterans’ Administration, both in Gainesville, was on how a team of pharmacists working with cardiologists and nurses improved and sustained quality of life for heart failure patients over a year of follow-up.
Both also were published in the Journal of Cardiac Failure.
In the first presentation, Kathleen Tong, MD, described how adult patients from 10 physician primary care practices were voluntarily enrolled in a pilot study for HF case management after being referred either by their primary care physician or a hospital at discharge during the first 10 months of 2012. Patients with both preserved and reduced ejection fractions were included.
For the study, minimum intervention included early contact from the pilot team, in-person patient assessment, medication reconciliation, HF education, and the development of patient-driven self-care goals, with additional counseling occurring as needed, either in person or over the telephone. Both a matched cohort from different practice sites within the system and the patients’ own historical outcomes prior to enrollment were used for comparison to clinical data collected during the study.
With a total of 486 patient encounters—77 at the clinic, 402 by telephone and seven by email—medication changes occurred 174 times. Because 49% of patients were nonadherent to at least one medication, 81 adherence interventions occurred. The most intensive level of care was provided to patients with more than 12 comorbidities who were taking more than 15 medications and had a recent admission to a hospital for HF care.
“Our data suggest that a HF nurse and pharmacist team working with PCPs under a standardized protocol can enhance access to care, reduce hospital use, and improve patient symptoms and self-care,” the authors write. “Supporting primary care sites with specialized ancillary staff and structured education may be an effective method to serve more heart failure patients outside of tertiary care centers.”
For the second study, presented by Richard S. Schofield, MD, consecutive heart failure patients admitted to the North Florida/South Georgia Veterans Health System in Gainesville, Florida, from October 2008 through September 2011, were screened and offered outpatient care via a postdischarge HF disease management program.
Baseline quality of life was assessed at the first clinic visit less than 14 days after hospital discharge, using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Minnesota Living With Heart Failure Questionnaire (MLWHF). With the questionnaires also answered at each outpatient clinic visit, scores were reassessed at 1, 3, 6, and 12 months.
The KCCQ (higher better) and MLWHF (lower better) scores improved significantly from baseline to 30 days—46.8 versus 50.3, P = 0.002; 55.0 versus 50.3; P < 0.001, respectively. Researchers found that quality of life remained significantly improved at 3 and 6 months and was numerically improved at 1 year with a very strong trend for significance in the MLWHF score.
“Over one year of follow-up we found an early and sustained improvement in HF-specific [quality of life] in a high risk group of patients managed via a multidisciplinary [heart failure disease management program],” the authors conclude, suggesting that a team involving pharmacists, nurses and cardiology can offer both short-term and sustained benefit for quality of life in heart failure patients.
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