Patients with chronic heart failure who plan their own self- care education decrease their outpatient visits

Abstract

Background, aims and objectives: Patient education programs delivering a defined package of information aimed to optimise the care of chronic heart failure have been evaluated. However, there is a lack of knowledge about the effects of programs designed to support the patients’ learning by allowing them to self-direct their learning activities. We aimed to contribute to the associated knowledge base.Method: We compared an intervention group of patients choosing among different learning activities with a control group, where the nurse practitioner scheduled a package of learning activities. One hundred and eighty two patients with chronic heart failure in NYHA class I-IV who were referred to the nurse practitioner outpatient clinic randomised to either a structured control education program (92 patients) or to a self-directed intervention program (90 patients). Additionally, both groups received the same nurse-practitioner based self-care advice and treatment. Outcome measures were quality of life, knowledge acquisition, visits to the outpatient clinic, readmissions and medication during one year.Results: All patients significantly increased their knowledge and quality of life, with no difference between the groups. However, the intervention group patients had fewer visits to the outpatient clinic as compared to controls (p=0.007). This was accomplished without a concomitant increase in re-admission rate. Both groups increased, as intended, their use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers.Conclusion: In conclusion, our findings show that it is safe and results in fewer outpatient visits if patients with chronic heart failure actively plan their own education program. To encouraging patients taking own decisions lead to an increased self-control of their healthcare behaviour.