Evaluation of Health Care Services Using a Multidisciplinary Care Model for Persons with Heart Failure at the Heart Failure Clinic, Ramathibodi Hospital

Abstract

              The aims of descriptive study was to evaluate elements of the health care service, self-care behavior, and opinions of persons with heart failure (HF) receiving care at the HF clinics, Ramathibodi Hospital. Donabedian’s quality of care model was use to guide the conceptual framework. Purposive sampling was used to recruit 31 persons with HF. Data were collected from July to October 2017, using  a personal data questionnaire, a health status data questionnaire, the structured interviews about self-care behaviors and the opinions of persons with HF receiving care from the heart failure clinics. Descriptive statistics was used for data analysis. Results showed that the majority of the subjects was males (58.1%) and ages ranged between 26 to 83 years with a mean of 56.8 years. Most of the subjects had stage C HF (83.9%) and 93% of subjects have been entered in the HF clinic more than 6 months. The baseline health status data indicated that most of the subjects had six- minute walk test (6 MWT) of less than 300 meters (51.6%), 90.3 percent of the subjects had left ventricular ejection fraction (LVEF) <40% and unable to work. All of the subjects had been hospitalized or visited an emergency room due to HF. After enrolling in HF clinic, about 71% of the subjects had 6 MWT more than 300 meters and of those LVEF of 25 persons had increased (80.65%). Only 3 persons with HF had been re-hospitalized and had never been visited emergency room. Regarding to self-care behaviors in relation to volume overload management, it was found that 100% of the subjects were able to limit the amount of salty food, monitoring of fluid overload (100%), assessing edema (96.8%), weight measurement (96.7%), adjusting diuretic medications (61.3%), and measuring fluid intake and output (83.9%). Most of the subjects (80.7%) exercised daily or at least 3-5 days per week. Most of the subjects had no sleeping disorders (61.3%); took medications regularly (77.4%). All of them had prior knowledge of factors that aggravate heart failure (100%). Almost all of them neither drank alcoholic beverages (90.3%), nor smoked (96.8%). Furthermore, all the subjects said that the HF clinic was beneficial as it assisted them with the adjustment of self-care behaviors, the services could be easily to access, and the consultation could be made via multiple communication channels. All of these multiple helping methods would be facilitated the favor clinical outcomes.  The findings of the study will assist health care providers to get a better understanding of the multidisciplinary approach taken at the HF clinic, in which nurse professional is considered as a key person in the HF clinic.