Randomized study of the effect of video education on heart failure healthcare utilization, symptoms, and self-care behaviors
Introduction
Chronic heart failure (CHF) is a predominant cause of morbidity and mortality in the United States [1]. In CHF, hypervolemia is associated with increased mortality [2], [3], [4]. Even clinically unrecognized hypervolemia in nonedematous patients (known as hemodynamic congestion) is associated with increased cardiac filling pressures and worse mortality [5]. Signs and symptoms of hypervolemia often lead to emergency care [6] and hospitalization for decompensated HF [7], [8], [9]. Due to distress associated with many hypervolemia symptoms, it is not surprising that patients with CHF have a high incidence of rehospitalization. Forty-four percent were readmitted at least one time within 6 months of index hospitalization [10]. Additionally, researchers found that hospitalization for CHF exacerbation was a forerunner of poor prognosis [11].
Self care behavior adherence in the medication plan and in lifestyle (low sodium diet, fluid management [daily weight monitoring and in some cases, fluid volume restriction], monitoring signs and symptoms and communicating changes with a health care provider, regular activity and smoking cessation), and self-management actions when signs and symptoms of CHF appear or worsen have been consistently emphasized in chronic CHF consensus guidelines since the mid 1990s as a means to lengthen intervals between episodes of hospitalization and improve quality of life [9]. This is because many self-care behaviors and self-management actions can positively affect intravascular and interstitial volume that ultimately lead to worsening of symptoms that prompt hospitalization and affect overall quality of life [12].
Education is an important precursor to adhering to the treatment plan and performing self-care behaviors. When patients received a 1-h RN led education session prior to CHF hospital discharge that included information about HF itself, prescription medications, diet, weight monitoring, smoking cessation, exercise, and warning signs of a worsening condition, adherence to self-care recommendations increased at 3 months, there was a significant reduction in 6 month rehospitalization for HF or other cardiovascular reasons, and reduced costs [13]. Unfortunately, current health care reimbursement programs generally do not reward hospitals or healthcare providers in the outpatient setting when they deliver one-on-one education sessions with enough breadth and depth to make a difference in patient behaviors that can lead to improved morbidity outcomes. Thus, verbal education is usually brief and does not provide a knowledge foundation that promotes self-care behaviors and self-management actions when signs and symptoms of HF worsen. Video education with breadth and depth of content may enhance verbal education after important self-care themes have been introduced. In CHF, video education may prompt adherence to self-care behaviors and self-management actions that could improve quality of life and reduce hospitalization.
When it comes to education, 75% of all information absorbed comes visually, about 13% comes from hearing and the rest comes from the other senses [14]. When patients can both see and hear information, they have an increased likelihood of paying attention to what is being taught and comprehending and retaining the information [14]. Therefore, video education offers some advantages for patients and their families. Small sound bytes of information can be delivered in a televised format and the material can be viewed at an individual pace and in a familiar, relaxing environment. Overwhelming content can be reviewed repeatedly until full understanding is achieved. The combination of words, pictures and actions by actual patients; especially when role modelling is used, makes the content themes appear realistic and achievable and might increase a patient's confidence in replicating what is seen and heard on video.
No video education studies in the literature reported the effects of video education in patients with chronic medical conditions; most were for surgical pre-admission or post-surgery education [15], [16], self-examination [17], smoking cessation [18] and rape/sexually transmitted disease prevention [19]. It is unknown if video education of CHF self-care behavior themes can enhance educator–patient interactions and promote adherence with CHF self-care. This pilot study was conducted to determine if video education (VE), in addition to standard education (SE), reduces urgent healthcare resource consumption; specifically, emergency care and hospitalization and improves post-discharge self-care and lifestyle behaviors, including patient-initiated actions for signs and symptoms of volume overload or fatigue within 3 months of the index hospitalization.
Section snippets
Sample and setting
This single center, prospective, experimental study was conducted in a large, urban, 1000 + bed tertiary medical center in a Midwestern United States city between May 2000 and July 2002. Using a convenience sample, 112 patients hospitalized for acute decompensation of CHF were approached. The institutional review board approved the protocol and all patients provided written informed consent. Men and women with an ejection fraction of 40% or less, aged 18–85 years, who were mentally alert, lived
Results
Patient characteristics, discharge medications, and previous healthcare utilization information at baseline are presented for SE and SE plus VE groups in Table 2. At baseline, learning styles and most patient characteristics were similar between groups. The majority of patients in both groups were treated by HF specialists (83% SE and 78% VE, P = 0.39) and intravenous inotropic agents were rarely used during acute treatment (1.9% SE and 1.8% VE, P = 0.96).
Prior to 3-month follow-up, 7 (6.3%) SE and
Discussion
This is the first study to examine the effects of VE on healthcare consumption, recommended lifestyle behaviors, HF self-care behaviors, and behaviors to overcome worsening HF signs or symptoms. The major findings of this study are that at 90 days, VE does not improve healthcare consumption but does reduce the need for extra diuretic dosing and telephone advice and prompts a request for HF literature. Patients in the VE group do not have more office visits than SE patients, reflecting no
Acknowledgements
Milner-Fenwick Inc. provided the heart failure videos for subjects randomized to the intervention group without charge.
We thank Linda Kelly RN, MSN, Diane Herron RN, MSN, and Melanie Hail RN, BSN for assisting with data collection. We also thank Kathryn Brock BA, CCRP and Tanya Ashinhurst for data entry and data cleaning and Songhua Lin MS for data management.
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