Case Management to Promote Fluid Self-management Among Patients With Heart Failure: A Pilot Study

Abstract

         This pilot study aimed to investigate the effects of case management to promote fluid self-management at Udonthani Hospital. A one-group quasi-experimental design with pre-posttest was used with a sample of 10 heart failure patients in Udonthani hospital. Data were collected in March 2024. The data collection tools included a general information record form, a fluid overload severity assessment form, a knowledge questionnaire on fluid overload management and a self-management assessment form to prevent fluid overload. The experimental intervention was a case management that consisted of a self-management program to prevent fluid overload in heart failure patients adapted from the framework of the Commission for Case Manager Certification (CMCC) and combined with the self-management framework by Creer. All tools had undergone quality assurance. Descriptive statistics was used to analyze baseline data. The Kruskal-Wallis test was employed to compare knowledge scores on self-management and a paired T-test was used to compare self-management for preventing fluid overload scores.

Result: The sample consisted of 70% males with an average age of 44 years and a median LVEF of 20%. After 28 days of implementing the case management program, one patient developed volume overload which calculated as an incidence of 3.66 per 1000 volume overload-free days (95%CI: 0.093 - 20.239). The median knowledge scores regarding fluid volume overload management significantly increased from 6.1 points before receiving the program to 9.8 points immediately after receiving the program, and to 10 points on 28 days after completing the program.        (p < 0.001). The self-management scores also significantly increased, with the mean difference of 11.20 points between before and after the program (95%CI: 9.81 - 12.58, p < 0.001).

Conclusion: The result of this study indicates that the case management program to          promote fluid self-management showed potential in improving patients' knowledge and            self-management abilities. However, further study with large sample size should be conducted to assure the effectiveness of case management program in preventing fluid volume overload.