Impact of Provider Self-Management Education, Patient Self-Efficacy, and Health Status on Patient Adherence in Heart Failure in a Veterans Administration Population

Authors

  • Usha Subramanian MD, MS,

    1. From the Roudebush VA Medical Center, Indianapolis, IN;1the Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN;2the Regenstrief Institute, Inc, Indianapolis, IN;3the Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, MI;4 and Wayne State University School of Social Work,5University of Michigan Medical School, Department of Plastic Surgery,6 Ann Arbor, MI
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  • 1,2,3 Faith Hopp PhD,

    1. From the Roudebush VA Medical Center, Indianapolis, IN;1the Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN;2the Regenstrief Institute, Inc, Indianapolis, IN;3the Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, MI;4 and Wayne State University School of Social Work,5University of Michigan Medical School, Department of Plastic Surgery,6 Ann Arbor, MI
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  • 4,5 Allison Mitchinson MPH,

    1. From the Roudebush VA Medical Center, Indianapolis, IN;1the Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN;2the Regenstrief Institute, Inc, Indianapolis, IN;3the Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, MI;4 and Wayne State University School of Social Work,5University of Michigan Medical School, Department of Plastic Surgery,6 Ann Arbor, MI
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  • and 4 Julie Lowery PhD 4,6

    1. From the Roudebush VA Medical Center, Indianapolis, IN;1the Division of General Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN;2the Regenstrief Institute, Inc, Indianapolis, IN;3the Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, MI;4 and Wayne State University School of Social Work,5University of Michigan Medical School, Department of Plastic Surgery,6 Ann Arbor, MI
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Usha Subramanian, MD, MS, Roudebush VA Medical Center, IF 122, 250 University Boulevard, Indianapolis, IN 46202
E-mail: usubrama@iupui.edu

Abstract

To address the need for more information on predictors of adherence to heart failure (HF) self-management regimens, this study analyzed surveys completed by 259 HF patients receiving care at 2 Veterans Affairs hospitals in 2003. Linear multivariable regression models were used to examine general health status, HF-specific health status (Kansas City Cardiomyopathy Questionnaire) self-management education, and self-efficacy as predictors of self-reported adherence to salt intake and exercise regimens. Self-management education was provided most often for salt restriction (87%) followed by exercise (78%). In multivariable regression analyses, education about salt restriction (P=.01), weight reduction (P=.0004), self-efficacy (P=.03), and health status (P=.003) were significantly associated with patient-reported adherence to salt restriction. In a similar model, self-efficacy (P=.006) and health status (P≤.0001), but not exercise education, were significantly associated with patient-reported exercise adherence. Findings suggest that provider interventions may lead to improved adherence with HF self-management and thus improvements in patients' health.

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