2.50
Hdl Handle:
http://hdl.handle.net/10755/157538
Type:
Presentation
Title:
AN INTERVENTION TO ENHANCE PATIENT ACTIVATION IN HEART FAILURE
Abstract:
AN INTERVENTION TO ENHANCE PATIENT ACTIVATION IN HEART FAILURE
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Kodiath, Mary F., MS, ANP-BC, RN
P.I. Institution Name:SDVAHS
Title:Nurse Practitioner
Contact Address:3350 LaJolla Village Dr., San Diego, CA, 92161, USA
Co-Authors:Ann E. Kelly; Nancy Gardetto; Carl Stepnowsky; Carolyn Larson; Martha Shively
PURPOSE: The purpose was to evaluate the implementation of an activation intervention on patient activation and self-care management in patients with heart failure. Lessons learned in implementing and evaluating the advanced practice nurse-led intervention will be shared.
RATIONALE: Heart failure care over the past decade has not fully explored patients' engagement or activation in their own care using the Chronic Care Model. This individualized, tailored intervention focused on activating the patient to acquire knowledge and skills needed for confident self-management.
METHODS: The intervention was a 6-month program developed to enhance self-management and was tailored to each participant's activation level. At the first individual meeting, the intervention/program leaders assessed patients' stage and level of activation as stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high). This baseline activation was assessed by both the patient's self-report score on the Patient Activation Measure (PAM) (Hibbard et al. 2005) and a brief interview. The tailored program focused on individualized self selected goals. Each participant met with the intervention nurse(s) for 6 sessions, by phone or in person. During these meetings their individualized health behavior goals were discussed, progress towards goals was reinforced and questions answered. Treatment fidelity was monitored by audio recording visits; these visits were reviewed by two members of the study team who were not part of the intervention.
RESULTS:
Thirty-nine individuals participated in the intervention. Baseline self-report PAM scores of activation showed 26% (10/39) at stage 1, 26% (10/39) at stage 2, 30% (12/39) at stage 3 and 18% (7/39) at stage 4. The facilitators rated no participants at stage 1, 33% (13/39) of the participants at stage 2, 46% (18/39) at a medium level of activation, stage 3, and 21% (8/39) at a high level of activation, stage 4. There was no more than one level of activation difference between the (PAM) self-reports and the facilitator rated interview for 80% (31/39) of the participants. Twenty percent (8/39) of participants had a difference of 2 or more levels and 7 of these had PAMscores lower than the interview rating.

Exercise was the most common self selected health behavior goal chosen (n=15 , 42%). Thirteen participants (33%) recorded weight, blood pressure and pedometer readings in month 2. This gradually declined to 10% (n=4) by month 6. Participants consistently voiced dislike of monitoring outcomes and recording behaviors. Overall participants were well informed regarding heart failure. Their knowledge needs were related to their health goals rather than general information.
IMPLICATIONS: The PAM was an effective tool to assess patients' level of activation and could be used in a clinic setting. Tools for monitoring outcomes and recording behaviors that participants like and will use need to be developed. Patient education needs to focus on how the individual can make health behavior related changes.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAN INTERVENTION TO ENHANCE PATIENT ACTIVATION IN HEART FAILUREen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157538-
dc.description.abstract<table><tr><td colspan="2" class="item-title">AN INTERVENTION TO ENHANCE PATIENT ACTIVATION IN HEART FAILURE</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kodiath, Mary F., MS, ANP-BC, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">SDVAHS</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Practitioner</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3350 LaJolla Village Dr., San Diego, CA, 92161, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mary.kodiath@va.gov</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ann E. Kelly; Nancy Gardetto; Carl Stepnowsky; Carolyn Larson; Martha Shively</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: The purpose was to evaluate the implementation of an activation intervention on patient activation and self-care management in patients with heart failure. Lessons learned in implementing and evaluating the advanced practice nurse-led intervention will be shared.<br/>RATIONALE: Heart failure care over the past decade has not fully explored patients' engagement or activation in their own care using the Chronic Care Model. This individualized, tailored intervention focused on activating the patient to acquire knowledge and skills needed for confident self-management. <br/>METHODS: The intervention was a 6-month program developed to enhance self-management and was tailored to each participant's activation level. At the first individual meeting, the intervention/program leaders assessed patients' stage and level of activation as stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high). This baseline activation was assessed by both the patient's self-report score on the Patient Activation Measure (PAM) (Hibbard et al. 2005) and a brief interview. The tailored program focused on individualized self selected goals. Each participant met with the intervention nurse(s) for 6 sessions, by phone or in person. During these meetings their individualized health behavior goals were discussed, progress towards goals was reinforced and questions answered. Treatment fidelity was monitored by audio recording visits; these visits were reviewed by two members of the study team who were not part of the intervention. <br/> RESULTS: <br/>Thirty-nine individuals participated in the intervention. Baseline self-report PAM scores of activation showed 26% (10/39) at stage 1, 26% (10/39) at stage 2, 30% (12/39) at stage 3 and 18% (7/39) at stage 4. The facilitators rated no participants at stage 1, 33% (13/39) of the participants at stage 2, 46% (18/39) at a medium level of activation, stage 3, and 21% (8/39) at a high level of activation, stage 4. There was no more than one level of activation difference between the (PAM) self-reports and the facilitator rated interview for 80% (31/39) of the participants. Twenty percent (8/39) of participants had a difference of 2 or more levels and 7 of these had PAMscores lower than the interview rating. <br/> <br/>Exercise was the most common self selected health behavior goal chosen (n=15 , 42%). Thirteen participants (33%) recorded weight, blood pressure and pedometer readings in month 2. This gradually declined to 10% (n=4) by month 6. Participants consistently voiced dislike of monitoring outcomes and recording behaviors. Overall participants were well informed regarding heart failure. Their knowledge needs were related to their health goals rather than general information.<br/>IMPLICATIONS: The PAM was an effective tool to assess patients' level of activation and could be used in a clinic setting. Tools for monitoring outcomes and recording behaviors that participants like and will use need to be developed. Patient education needs to focus on how the individual can make health behavior related changes. <br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:57:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:57:55Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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