To examine the association between frequency of family member accompaniment to medical visits and heart failure (HF) self-care maintenance and management and to determine whether associations are mediated through satisfaction with provider communication.
Methods
Cross-sectional survey of 150 HF patients seen in outpatient clinics. HF self-care maintenance and management were assessed using the Self-Care of Heart Failure Index. Satisfaction with provider communication was assessed using a single question originally included in the American Board of Internal Medicine Patient Satisfaction Questionnaire. Frequency of family member accompaniment to visits was assessed using a single-item question. We performed regression analyses to examine associations between frequency of accompaniment and outcomes. Mediation analysis was conducted using MacKinnon’s criteria.
Results
Overall, 61% reported accompaniment by family members to some/most/every visit. Accompaniment to some/most/every visit was associated with higher self-care maintenance (β = 6.4, SE 2.5; p = 0.01) and management (β = 12.7, SE 4.9; p = 0.01) scores. Satisfaction with provider communication may mediate the association between greater frequency of accompaniment to visits and self-care maintenance (1.092; p = 0.06) and self-care management (1.428; p = 0.13).
Discussion
Accompaniment to medical visits is associated with better HF self-care maintenance and management, and this effect may be mediated through satisfaction with provider communication.
Lloyd-JonesDAdamsRCarnethonM. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation2009; 119: 480–486.
2.
RossJSChenJLinZ. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail2010; 3: 97–103.
3.
JoyntKEJhaAK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes2011; 4: 53–59.
4.
EpsteinAMJhaAKOravEJ. The relationship between hospital admission rates and rehospitalizations. N Engl J Med2011; 365: 2287–2295.
5.
MarmotMGWilkinsonRG (eds). Social determinants of health, Oxford; New York: Oxford University Press, 1999.
6.
TaoHEllenbeckerCHChenJ. The influence of social environmental factors on rehospitalization among patients receiving home health care services. ANS Adv Nurs Sci2012; 35: 346–358.
7.
TsuchihashiMTsutsuiHKodamaK. Medical and socioenvironmental predictors of hospital readmission in patients with congestive heart failure. Am Heart J2001; 142: E7–E7.
8.
HershAMMasoudiFAAllenLA. Postdischarge environment following heart failure hospitalization: expanding the view of hospital readmission. J Am Heart Assoc2013; 2: e000116–e000116.
9.
ArbajeAIWolffJLYuQ. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist2008; 48: 495–504.
10.
CeneCWHaymoreLBDolan-SotoD. Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure. J Card Fail2013; 19: 202–210.
11.
CameronJWorrall-CarterLRiegelB. Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure. Heart Lung2009; 38: 410–418.
12.
HeoSMoserDKLennieTA. Gender differences in and factors related to self-care behaviors: a cross-sectional, correlational study of patients with heart failure. Int J Nurs Stud2008; 45: 1807–1815.
13.
RockwellJMRiegelB. Predictors of self-care in persons with heart failure. Heart Lung2001; 30: 18–25.
14.
RiegelBLeeCSDicksonVV. An update on the self-care of heart failure index. J Cardiovasc Nurs2009; 24: 485–497.
15.
Laidsaar-PowellRCButowPNBuS. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns2013; 91: 3–13.
16.
WolffJLRoterDL. Hidden in plain sight: medical visit companions as a resource for vulnerable older adults. Arch Intern Med2008; 168: 1409–1415.
17.
LuttikMLJaarsmaTMoserD. The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature. J Cardiovasc Nurs2005; 20: 162–169.
18.
RiegelBMoserDKAnkerSD. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation2009; 120: 1141–1163.
19.
HuntSAAbrahamWTChinMH. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation2009; 119: e391–e479.
20.
RoslandAMHeislerMChoiHJ. Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?. Chronic Illn2010; 6: 22–33.
21.
SayersSLWhiteTZubritskyC. Family involvement in the care of healthy medical outpatients. Fam Pract2006; 23: 317–324.
22.
BotelhoRJLueBHFiscellaK. Family involvement in routine health care: a survey of patients' behaviors and preferences. J Fam Pract1996; 42: 572–576.
23.
AndresenEMMalmgrenJACarterWB. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med1994; 10: 77–84.
24.
KatzmanRBrownTFuldP. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatr1983; 140: 734–739.
25.
SmilksteinGAshworthCMontanoD. Validity and reliability of the family APGAR as a test of family function. J Fam Pract1982; 15: 303–311.
26.
RoslandAMPietteJDChoiH. Family and friend participation in primary care visits of patients with diabetes or heart failure: patient and physician determinants and experiences. Med Care2011; 49: 37–45.
27.
American Board of Internal Medicine. Patient satisfaction questionnaire: guide to awareness and evaluation of humanistics qualities in the internist, Philadelphia, PA: American Board of Internal Medicine, 1988.
28.
The R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: Foundation for Statistical Computing, 2013, http://www.R-project.org/ (accessed 1 April 2014).
29.
BaronRMKennyDA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol1986; 51: 1173–1182.
30.
MacKinnonDPLockwoodCMHoffmanJM. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods2002; 7: 83–104.
31.
GallagherRLuttikMLJaarsmaT. Social support and self-care in heart failure. J Cardiovasc Nurs2011; 26: 439–445.
32.
SayersSLRiegelBPawlowskiS. Social support and self-care of patients with heart failure. Ann Behav Med2008; 35: 70–79.
33.
RiegelBLeeCSDicksonVV. Self care in patients with chronic heart failure. Nat Rev Cardiol2011; 8: 644–654.
34.
RiegelBVaughan DicksonVGoldbergLR. Factors associated with the development of expertise in heart failure self-care. Nurs Res2007; 56: 235–243.
35.
Samuel-HodgeCDCeneCWCorsinoL. Family diabetes matters: a view from the other side. J Gen Intern Med2013; 28: 428–435.
36.
RoslandAMHeislerMPietteJD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med2012; 35: 221–239.
37.
ClaymanMLRoterDWissowLS. Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits. Soc Sci Med2005; 60: 1583–1591.
38.
IshikawaHRoterDLYamazakiY. Physician-elderly patient-companion communication and roles of companions in Japanese geriatric encounters. Soc Sci Med2005; 60: 2307–2320.
39.
WolffJLRoterDL. Family presence in routine medical visits: a meta-analytical review. Soc Sci Med2011; 72: 823–831.
40.
MorrisSMThomasC. The carer's place in the cancer situation: where does the carer stand in the medical setting?. Eur J Cancer Care (Engl)2001; 10: 87–95.
41.
BaroneADYoelsWCClairJM. How physicians view caregivers: Simmel in the examination room. Sociol Perspect1999; 42: 673–690.
Levine C. Family caregivers and health care professionals working together to improve care. New York, NY: United Hospital Fund, 2013, http://www.uhfnyc.org/publications/880925 (accessed 11 December 2013).
44.
Institute for patient- and family-centered care, http://www.ipfcc.org/ (accessed 11 December 2013).
