Assessment and education keys to CHF program
Patients have 24-hour access to staff
When patients are identified for the congestive heart failure (CHF) program at Harvard Vanguard Medical Associates, they are scheduled for an assessment by the CHF staff.
The hour-long visit includes a full physical assessment, an assessment of all drugs the patient is taking, and an informational and teaching session. Patients are given information on their particular form of CHF, what caused it, what medications can help with it, and what symptoms to look for at home.
For instance, patients are told specifically to weigh themselves daily, and if their weight goes up by more than two pounds, to call the CHF program.
After the initial visit, patients come to the clinic weekly. As they improve, their visits are cut to monthly. The staff also call patients regularly to check on their weight status and symptoms.
"We have found that if you’re not diligent in supervising the patients, they may fail to monitor their symptoms, stop weighing themselves daily, and start eating the wrong kinds of food," Gilworth says.
Patients initially are called weekly. That drops off to monthly when they become stable. They are encouraged to check in with the staff at regular intervals, depending on their condition and what works well for them.
"Some check in on a daily basis, and have since they entered the program. Others check in monthly," Gilworth says.
When patients’ symptoms exacerbate, they can get in touch with their primary clinicians via beeper 24 hours a day. All staff members have access to a database that includes pertinent information on all patients, including weight and medication, allowing the three staff members to cover for each other.
Every quarter, all patients fill out a quality-of-life assessment form that rates how they feel about their symptoms. Also, each patient does a six-minute walk designed to test functional capacity. The walk gives the staff an idea of how short of breath the patients may be as they carry on their activities of daily living. "Unlike the treadmill, which tests exercise capacity, this tests daily living capacity," Gilworth says. It’s an objective measure that allows patients to see how they improve over time, she adds.
The program is designed to fit each patient’s individual needs. "Patients don’t fit in a little box. It depends on their personality. Some have difficulty with the beepers. In that case, we have them call our voice mail, or we call them," she says.
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