title: Congestive heart failure adherence redesign trial: a pilot study.
abstract: OBJECTIVE
  Heart failure (HF) continues to be a leading cause of hospital admissions, particularly in underserved patients. We hypothesised that providing individualised self-management support to patients and feedback on use of evidence-based HF therapies (EBT) to physicians could lead to improvements in care and decrease hospitalisations. To assess the feasibility of conducting a larger trial testing the efficacy of this dual-level intervention, we conducted the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a proof-of-concept, quasi-experimental, feasibility pilot study.
  
  
  METHODS
  A large tertiary care medical centre in Chicago.
  
  
  METHODS
  Low-income patients (<US$30,000/year) hospitalised for exacerbation of systolic HF (ejection fraction ≤50%) and their physicians. Twenty physicians and 33 patients were enrolled, of whom 23 patients completed the study.
  
  
  METHODS
  Physicians received HF guidelines and periodic individualised feedback on their adherence to EBT. Patients received HF education, support and self-management training for diet and medication adherence by a trained nurse through 11 interactive sessions over a 4-month period. Evaluations were conducted pre-enrolment and 1 month postintervention completion.
  
  
  METHODS
  Feasibility was assessed by the ability to deliver intervention to patients and physicians. Exploratory outcomes included changes in medication and sodium intake for patients and adherence to EBT for physicians.
  
  
  RESULTS
  Eighty-seven per cent and 82% of patients received >80% of interventions at 1 month and by study completion, respectively. Median sodium intake declined (3.5 vs 2.0 g; p<0.01). There was no statistically significant change in medication adherence based on electronic pill cap monitoring or the Morisky Medication Adherence Scale (MMAS); however, there was a trend towards improved adherence based on MMAS. All physicians received timely intervention.
  
  
  CONCLUSIONS
  This pilot study demonstrated that the protocol was feasible. It provided important insights about the need for intervention and the difficulties in treating patients with a variety of psychosocial problems that undercut their effective care.
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Department of Internal Medicine, OSF St. Francis Medical Center, Peoria, Illinois, USA.
authors.forename: Ashvarya
authors.initials: A
authors.lastname: Mangla
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Doukky
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Avery
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA Department of Mathematics, Lake Forest College, Lake Forest, Illinois, USA.
authors.forename: DeJuran
authors.initials: D
authors.lastname: Richardson
authors.affiliation: Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: James E
authors.initials: JE
authors.lastname: Calvin
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
keywords: QUALITATIVE RESEARCH