BACKGROUND/RATIONALE:
Heart failure (HF) is a major chronic condition in the United States and within Veterans Affairs hospitals (VA). The burden of HF has increased and is estimated to increase further over several decades as the population ages. HF disproportionately affects black compared with white Americans. Given that HF is chronic condition, adherence to recommended lifestyle and medical treatments has a significant impact on outcomes. Studies have shown that communication in medical interactions is associated with outcomes in other conditions, but this relationship is poorly studied in HF.


OBJECTIVE(S):
The objective of this study is to assess the relationship of communication with outcomes in patients with HF. We hypothesized that outpatient medical visits with more effective patient physician communication are associated with better HF outcomes, improved patient perceptions and improved adherence. We also hypothesized that for a number of reasons black patients would have more difficulty communicating with physicians when compared with white patients.

METHODS:
Patients were recruited for a prospective observational cohort study at two VA hospitals. Eligible patients were age 25 or older and had an exacerbation of HF requiring hospital admission or an emergency room visit. Patients whose HF was secondary to an acute condition, had dementia, or were discharged to a nursing home were excluded. Data were collected at hospital admission or after release from the emergency room, at up to two subsequent outpatient visits and at approximately 6 months after discharge using questionnaires. Patient questionnaires provided demographics, HF specific functional status, ratings of patients' own and ratings of their physicians' communication, satisfaction, self-efficacy, trust in physician and VA, experiences of discrimination in healthcare, and patients' beliefs about causes of HF. An adherence questionnaire was completed by telephone approximately 4 weeks after each outpatient visit. Chart reviews collected several clinical characteristics including comorbid conditions, unscheduled visits and readmissions. Visits with consenting physicians were audio-taped. Audio-tapes were transcribed and coded for patient and physician communication behaviors. Analyses continue with appropriate statistics to explore bivariate relationships and to examine independent relationships after controlling for multiple co-variates.

FINDINGS/RESULTS:
In this cohort of heart failure patients, age, functional status, patients' trust in physician, and patients' ratings of their own and their physicians' communication were associated with adherence at four week follow-up to physicians' recommendations. However, in repeated measures linear regression analyses controlling for a number of co-variates, we found that trust was not a significant predictor adherence, while patients' rating of doctors' informativeness, age and functional status were significant (P<.05) predictors of adherence. Also and contrary to our hypothesis we did not find that race was a significant predictor of communication, trust, or adherence in these analyses.

IMPACT:
Information is an important resource for patients to self-manage their medical conditions. Our results highlight the relationship of physicians' informativeness with patients' adherence to physicians' recommendations. Research that tests interventions and educational efforts to improve the dynamics of patient-clinician communication may assist the VA in efforts to improve health and health care.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: none
DRE: none
Keywords: Cardiovasc’r disease, Communication -- doctor-patient, Ethnic/cultural
MeSH Terms: none