New York study finds poor CHF counseling methods
Information provided as little as 6% of the time
A quality improvement study conducted by IPRO, a nonprofit health care quality evaluation organization in Lake Success, NY, has found that patient counseling and education were lacking in many areas regarding congestive heart failure (CHF) in a group of New York hospitals.
When evaluating data from 686 inpatient records of Medicare patients hospitalized with CHF in 186 New York hospitals in 1993, general counseling about the disease was only provided 6% to 26% of the time, depending on the hospital. Recommendations about activities to avoid were provided in 87% of cases, but only 20% of patients received specific instruction outlining those activities, such as the type of exercise patients should follow. The study was funded by the Health Care Financing Administration in Washington, DC, the agency that oversees Medicare.
These are other findings of the study:
• Dietary consultations took place 74% of the time, and a discharge diet was provided to 90% of patients, but a copy of a discharge diet was provided to only 14% of patients.
• Advice to avoid excess fluid intake was given only 9% of the time.
• Medication education including drug names and dosages occurred in 96% of cases, but only 10% of patients were told of possible side effects and 3% the consequences of missing a dose.
• Documentation of discharge planning varied between facilities, from 81% to 97% of patients.
Raphael P. Nenner, MD, vice president of medical affairs for IPRO, says physicians and other caregivers should do a better job of counseling patients about CHF in order to increase compliance with medications, diet, and other necessary factors.
"Patients and their families should be counseled regarding the nature of CHF, dietary restrictions, symptoms of worsening heart failure, actions to take if symptoms worsen, and the prognosis," he says.
Nenner recommends that hospitals follow recommendations from the Agency for Health Care Policy and Research (AHCPR) in Rockville, MD, regarding the treatment of patients with CHF, which includes guidelines on patient counseling.1
[Editor’s note: To obtain a free copy of the AHCPR guideline, contact: AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. Telephone: (800) 358-9295.]
Reference
1. Konstam M, Dracup K, Baker D, et al. Heart Failure: Evaluation and Care of Patients With Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11. AHCPR Publication No. 94-0612. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; June 1994.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content