Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial.
Heart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence.



In this two-group, repeated measures randomized control trial, the main outcomes were patient reported and clinical outcomes associated with SM adherence, and all-cause readmission at 30, 90 and 180 days.



The study included 100 HF patients discharged from a rural critical access hospital. The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects' activation levels. At α = .10, the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence: weighing themselves, following a low-sodium diet, taking prescribed medication, and exercising daily (all p < .0005) at 3 and 6 months after discharge. In contrast, groups did not differ in physical activity assessed by actigraphy or in clinical biomarkers. Contrary to expectation, the 30-day readmission rate was significantly higher (p = .088) in the intervention group (19.6 %) than in the control group (6.1 %), with no differences at 90 or 180 days.



It is feasible to conduct a randomized controlled trial in HF patients discharged from rural critical access hospitals. Significantly higher patient-reported SM adherence was not accompanied by lower clinical biomarkers or readmission rates. Further research is needed to understand mechanisms that influence outcomes and healthcare utilization in this population.







ClinicalTrials.gov; NCT01964053 .
Department of Physiological and Technological Nursing, College of Nursing Augusta University, 987 St. Sebastian Way, Augusta, GA, 30912, USA. luyoung@augusta.edu.
Lufei
0000-0001-5056-4777
L
Young
University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA.
Melody
M
Hertzog
University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska, USA.
Susan
S
Barnason
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004039:Diet, Sodium-Restricted; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D010359:Patient Readmission; D015397:Program Evaluation; D019035:Rural Health Services; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents