Trial of Education and Compliance in Heart Dysfunction. A Study Measuring the Impact of Multi-disciplinary Education as an Intervention to Increase Patient Concordance and the Cost Effectiveness of Treatment in Patients With Heart Dysfunction
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 383
- 试验地点
- 4
- 主要终点
- Clinical Outcomes: data collected on all cause mortality, all cause readmissions and all cause emergency room visits
研究概览
简要总结
The emphasis of this grant is to investigate ways to educate patients, not only to improve their knowledge about medications and diet that are important for better outcomes in heart failure, but also to try to understand how patients' beliefs about medication and diet affect their behaviour and to what extent the investigators can help patients change.
Hypotheses: Heart failure patients who receive an enhanced educational intervention from their community pharmacist will:
- have an absolute risk reduction in the number of events of 20%,
- be more compliant,
- demonstrate less health-related quality of life (HRQoL) impairment as measured by disease-specific and generic HRQoL instruments and
- have lower costs/quality adjusted life years due to fewer total events per patient.
详细描述
INTRODUCTION: Heart Failure (HF) is one of the leading causes of hospitalization in Canada. While great advances have been made in the treatment of this disease, factors limiting the effectiveness of treatment include: poor compliance to dietary guidelines and medications, patients' lack of understanding about the impact of their disease, a lack of understanding of the impact of their lifestyle habits on their disease and the lack of systematic monitoring of patients following hospitalization. The objective of this trial of education and compliance in heart failure patients (TEACH) is to measure in patients with heart failure who are hospitalized and then discharged into the community, the impact of a comprehensive outpatient educational intervention on:
- a composite endpoint of mortality, readmissions and visits to the emergency room for all causes,
- the impact of the intervention on health-related quality of life,
- the impact of the intervention on compliance to medication and
- the economic impact of providing such an intervention to patients. A unique component of this study is the participation of community pharmacists as part of a seamless care model and the economic and qualitative evaluation of the educational interventions.
RESEARCH DESIGN: This is a prospective, randomized controlled clinical trial in patients who are admitted to the hospital with a diagnosis of heart failure. Patients are stratified by reason for admission to the hospital. Stratum 1 includes patients whose primary reason for admission is HF and stratum 2 includes patients whose primary reason for hospital admission is not HF. The randomization will follow a cluster randomization design such that the community pharmacies will be randomized to deliver either an intervention (INTERVENTION) or usual care (CONTROL). Patients will be assigned to one of the two arms contingent upon which pharmacy they obtain most of their medications from. All patients receive standardized in-hospital education that has been previously validated (Eur J of HF, in press 2003). This education consists of educational booklets and videos on HF, health promotion and dietary information as well as relevant intervention from their community pharmacist that is aimed at helping the patients become more compliant with their medication and provide a framework of understanding that helps persistence.
HYPOTHESIS: HF patients who receive an enhanced educational intervention from their community pharmacist will:
- have an absolute risk reduction in the number of events of 20%,
- be more compliant,
- demonstrate less health-related quality of life (HRQoL) impairment as measured by disease-specific and generic HRQoL instruments and
- lower costs/quality adjusted life years (QALY) due to fewer total events per patient.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical history of dyspnea
- •Concurrent physical exam consistent with rales, S3, elevated JVP, pedal oedema
- •Heart failure (HF) confirmed by attending physician, if patient is assessed by house staff
- •Left ventricular ejection fraction (LVEF) < 40% on echocardiogram, nuclear scan or contrast ventriculography
- •Indications for chronic medical treatment for HF
- •Able and willing to give informed consent
- •Over 18 years of age
- •Live within London, Ontario and surrounding area, defined by the boundaries as the London and District Pharmacists' Association
排除标准
- •Planned surgical correction for HF within 12 months
- •Cor pulmonale and only right ventricular failure
- •Chronic renal failure on dialysis (these patients are followed by nephrology educators)
- •Other illnesses with survival anticipated for < 12 months
- •Dementia documented by attending physician
- •Psychiatric illness that makes it impossible to respond to education through the community pharmacist
- •Planned discharge to long term institution
- •Barrier to teaching (English is not the first language AND caregiver cannot provide translation to the patient to elicit the patient's responses)
- •Severe alcohol or drug abuse
- •Refusal to participate
结局指标
主要结局
Clinical Outcomes: data collected on all cause mortality, all cause readmissions and all cause emergency room visits
时间窗: at one year
次要结局
- Baseline outcome measurements and quality of life(One year)
- Medication compliance(One year)