ABSTRACT
OBJECTIVE: To describe the frequency, roles, and utility of family companion involvement in the care of patients with Heart Failure (HF) care and to examine the association between audiotaped patient, companion, and provider communication behaviors. METHODS: We collected survey data and audiotaped a single medical visit for 93 HF patients (36 brought a companion into the examination room) and their cardiology provider. Communication data was analyzed using the Roter Interaction Analysis System. RESULTS: There were 32% more positive rapport-building statements (p<0.01) and almost three times as many social rapport-building statements (p<0.01) from patients and companions in accompanied visits versus unaccompanied patient visits. There were less psychosocial information giving statements in accompanied visits compared to unaccompanied patient visits (p<0.01.) Providers made 25% more biomedical information giving statements (p=0.04) and almost three times more social rapport-building statements (p<0.01) in accompanied visits. Providers asked fewer biomedical and psychosocial questions in accompanied versus unaccompanied visits. Providers made 16% fewer partnership-building statements in accompanied versus unaccompanied visits (p=0.01). CONCLUSIONS: Our findings are mixed regarding the benefits of accompaniment for facilitating patient-provider communication based on survey and audiotaped data. PRACTICE IMPLICATIONS: Strategies to enhance engagement during visits, such as pre-visit question prompt lists, may be beneficial.
Subject(s)
Communication , Family/psychology , Heart Failure/therapy , Office Visits , Patient Participation , Tape Recording , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , North Carolina , Office Visits/statistics & numerical data , Patient Satisfaction , Physician-Patient Relations , Primary Health Care , Social SupportABSTRACT
PURPOSE: Cardiac rehabilitation (CR) has been shown to generally increase functional capacity and lower cardiovascular morbidity in patients with ischemic heart disease. The effectiveness of CR in female participants, however, is unclear. We thus examined whether improvement in functional capacity after CR differs between men and women with ischemic heart disease. METHODS: Our study was a retrospective cohort study that included 1104 participants (346 women and 758 men) enrolled in CR from 2002 through 2011. We measured change in metabolic equivalents (METs) after CR to assess improvement in functional capacity in male and female participants. We considered various potential confounders, including baseline METs, CR referral indication, age, race, body mass index, baseline cholesterol, and home zip code average prosperity. RESULTS: Men experienced a greater improvement in METs following CR in all models, including the unadjusted model (2.16 METs in men, 1.65 METs in women; P = .0001), the model adjusting for CR indication only (2.15 METs in men, 1.67 METs in women; P = .0003), and the model adjusting for age, body mass index, and CR indication (2.12 METs in men, 1.66 METs in women; P = .0004). CONCLUSIONS: We show that men obtain greater benefit from current CR programs than do women. This implies that tailoring CR programs to women may yield further improvement in functional capacity for female CR participants.
