Care Collaboration Helps Patients with At-Risk Heart Failure Illness
By Melinda Young
Researchers found social support and care affordability are important to obtain better outcomes among patients with heart failure and reduced ejection fraction.1
“We found social support and affordability of care are really important for most of the outcomes, whereas socioeconomic position and patient demographics only affect a narrow set,” says Sandra B. Dunbar, RN, PhD, a research professor at Emory University Nell Hodgson Woodruff School of Nursing. “Our study built on the growing body of literature about the impact of social determinants of health, health equity, and health outcomes. We were interested in looking at some of the social determinants of health in relationship to patient-centered outcomes.”
Other researchers have studied social determinants of health and their potential effect on patients’ overall well-being, morbidity, and mortality. “We wanted to look at some of the things related more to patient-centered outcomes and patients’ perception of their health status,” Dunbar says.
Patients with heart failure and reduced ejection fraction completed a 30-minute online survey. Dunbar and colleagues studied their socioeconomic position, affordability of care, demographics, and social support. The patient-centered outcomes included:
- Heart failure-specific health status;
- Medication adherence;
- Treatment satisfaction and burden;
- Psychosocial symptoms, including depression, anxiety, and insomnia.
“We found there was a large percentage who thought their health status was poor or fair,” Dunbar says. “We found that if people perceived their medication as affordable or if they were married, those individuals had better health status.”
Women, patients with dual Medicaid and Medicare, and those who were uninsured reported higher levels of depression. Anxiety also was associated with Medicaid, dual Medicaid and Medicare, or no insurance.
Assess Social Determinants of Heath
The findings suggest case managers and providers should assess social determinants of health when working with heart failure patients with reduced ejection fraction, Dunbar says. This group reports heavier symptom burden.
“We believe having greater understanding of social determinants of health would inform care delivery models for chronic heart failure,” Dunbar says.
The research highlights the need for more social support. “We want to suggest that more effective screening and targeted social support may be warranted for certain individuals,” Dunbar says.
It is not enough to assume married patients are supported adequately. Not all spouses can help patients manage their symptoms and social determinants of health. “We need more in-depth questioning of patients’ support needs,” Dunbar adds.
These additional questions could include:
- Can they afford medications?
- Do they need assistance?
- What is getting in the way of your managing heart failure?
“Those are possible targets for greater intervention,” Dunbar explains. “Do that broad level of assessment and provide educational counseling and referrals to facilitate access to whatever could help resolve the problem.”
It also would help for a health system’s electronic health record to include social determinants of health in its assessment parameters. “This will help providers better understand the patient’s perceptions of their care needs that might not be assessed through our traditional clinical questions,” Dunbar says.
Some patients may need referral to a social worker or case manager who can help facilitate family and social support assistance. “Healthcare providers are becoming more aware of the need to address these social issues through the development of programs and adding members to the care team who can facilitate appropriate access to care,” Dunbar says.
- Dunbar SB, Tan X, Lautsch D, et al. The association between social determinants of health and patient-centred outcomes in adults with heart failure with reduced ejection fraction. J Adv Nurse 2023;May 2. doi: 10.1111/jan.15682. [Online ahead of print].
Researchers found social support and care affordability are important to obtain better outcomes among patients with heart failure and reduced ejection fraction.
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