Implementing Heart Failure Self-Management Teaching in a Primary Care Setting

The American Heart Association recommends that heart failure self-management education be provided at every healthcare visit. Despite this recommendation, self-management education is rarely done at primary care visits. Heart failure has become a common cause for hospitalizations in Medicare patients and is also one of the most common causes of hospital readmissions in the country. The high prevalence of heart failure, high hospitalization rates, lack of a cure, and increasing life expectancies all contribute to the thirty-two billion dollar annual cost of heart failure in the United States. The American Heart Association has recently released guidelines that recommend that at each patient encounter, providers should educate heart failure patients on structured self-management. Despite this guideline, primary care providers rarely teach self-management programs. The overall objective of this project is to increase heart failure self-management education in the primary care setting. The individual objectives of this project include: to develop a manual on heart failure self-management education for healthcare providers, to implement a heart failure self-management education program in a primary care setting, to evaluate the impact of the heart failure self-management education program by comparing the pre- and post- implementation education charted on patients, and to disseminate the results to a wider audience. Self-management programs have been shown to improve outcomes of many chronic diseases including heart failure. These programs give patients the resources and skills to make treatment decisions based on how they are doing at the time. The programs also increase patients' understanding of their illness. Due to the increase in self-monitoring and education, patients can make better decisions that lead to increased physiological stability. The common outcomes of the self-care management programs include: decreased symptoms, increased stability, slower progression, better understanding of the illness, and a reduction for all-cause hospitalizations in patients. This leads to an annual savings of between $1,300 and $7,515 per patient each year. The self-care management program developed for this project was implemented at one primary care clinic in Northern Utah. The program used an education manual for the clinic staff and patient resources from the Heart Failure Society of America and American Heart Association. A pre-education heart failure chart review was conducted on 25 charts to look for heart failure documentation. Similarly a post-education chart review was conducted on 25 charts to look for the same documentation. The program had a significant change in documented teaching rates (p=0.012) pre- and post-program implementation. The clinic staff reported that they were satisfied with the program, but that time was the biggest barrier to the education being consistently performed and documented. This project significantly increased heart failure self-management education at this rural primary care clinic. If it can be adapted to other settings and become self-sustaining, it may be useful for other heart failure patients.