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  • TEC3: What kind of training and information should be provided for the patient who uses Structured telephone support (STS) for adult patients with chronic heart failure, or for his family?
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What kind of training and information should be provided for the patient who uses Structured telephone support (STS) for adult patients with chronic heart failure, or for his family?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

Internal reviewers: Alessandra LoScalco, Antonio Migliore, Christina Mototolea, Silvia Gabriela Scintee

The basic literature search and one additional reference were used. Forteen studies ({3}, {37}, {15}, {16},{22}, {32}, {31},{11},{17},{27}, {58}, {59}, {43},{47})  provided answer to this question, whereas 12 of them are systematic reviews, one an RCT {43}, and one an HTA {47}.

In the forteen included studies for this question the following training/ patient education aspects were adressed:

General heart failure education

-detection of deterioration

-use of medication

-diet

-physcial activity/ exercise training

-Smoking cessation

Telemonitoring specific training

-training to use devices (technically)

-training to manage the information (empowerment and self-care), interpret the vital signals and efficiently utilize them

Other training/ education

-coping with difficult emotions

-relaxation and cognitive symptom management techniques

-lifestyle aspects: alcohol intake, sexual activity

-necessity of vaccinations

-capabilities of patients to travel or work

-coping with individual problems, often related to comorbid conditions

-training of relatives/ caregivers

How is the training provided:

-in groups of 10-15 people, where patients can assist and help each other

-through leaflets and online manuals, depending on the service

  • home visits
  • videophone
  • telephone calls or letters to the patient at home
  • 1-hours, in-person patient education program with usual discharge care
  • by technology through predischarge viewing of an educational CD-RIM
  • video to be viewed at home
  • predischarge nurse-led intensive education about HF symptoms and treatment followed by 1 telephone to reinformce education

Patient education

Fiveof the included reviews adressed

  • education on HF in general {37} {16} {31} {11}

-detection of deterioration {37}

  • advice and instruction on use of medication {37} {16} {31}
  • diet {37} {16} {31}
  •  physcial activity/ exercise training {37} {31}
  • symptom monitoring and self-management advice {16} {31} {11}
  • training in the use of equipment {11} {15}

One systematic review also adressed

-Smoking cessation coping with difficult emotions {37}

- communication with family and healthcare providers, using relaxation and cognitive symptom management techniques {37}

-alcohol intake {37}

-sexual activity {37}

-necessity of vaccinations {37}

-capabilities of patients to travel {37}

-individual problems related to comorbid conditions{37}

 

Implementation of education:

  • home visits {16}
  • videophone {16}
  • home physiological monitoring {16}
  • telephone calls or letters to the patient at home{16}
  • 1-hours, in-person patient education program with usual discharge care {3}
  • HF education delivered by technology through predischarge viewing of an educational CD-ROM {58}
  • a 60-minute video that was intended to be viewed at home {59}
  • predischarge nurse-led intensive education about HF symptoms and treatment followed by 1 telephone call 3 to 5 days after discharge to reinforce education {43}
  • in groups of 10-15 people, where patients can assist and help each other{47}
  • through leaflets and online manuals {47}

Statements about patient education among the included studies:

  • Education and training is seen as the basic for effective monitoring and decision making. {47}
  • the greatest benefit in terms of education and medication patterns is accrued within a few weeks and that long-term monitoring is redundant {32} {31}
  •  Eliminating the travel time for nurses by using tele-education could help reduce workload {11}
  • knowledge allows the patients to take greater responsibility for their own care and management {11}
  •  increased patient empowerment can help reduce reliance on the nurse {11}
  • The caregiver and relatives can also be important, as they can assist the patient with monitoring and help if needed {47}

Evaluation of patient education:

„Moreover, although the provision of education during remote follow-up would theoretically lead to improved self-care in patients with heart failure, a recent review that focused specifically on this issue noted that results from trials are equivocal.“ {17}

„As early as 2002, Krumholz et al identified education as a key point in global management of HF; leading a 37% reduction (P=0,004) if readmission to the hospital for HF or for cardiovascular disease.“ {27}

Critical
Completely
Wilbacher I, Rupel V Result Card TEC3 In: Wilbacher I, Rupel V Description and technical characteristics of technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

References