Weight and symptom diary for self-monitoring in heart failure clinic patients.

BACKGROUND: For people with chronic heart failure, self-monitoring has been linked with improved body awareness and better communication with health professionals. Cognitive theory and the concept of somatic awareness help explain self-monitoring behaviors. This study compares the clinical and hospital outcomes of heart failure patients who are using and not using a diary to record weight, vital signs and, symptoms and evaluates the diary format. METHODS: All patients enrolling in an outpatient heart failure clinic were given a Heart Health Diary. Seventy patients used the diary and 54 did not. A review of these 124 patients (82 men and 42 women) was completed 6 months after enrollment. RESULTS: Diary nonusers were more likely to be younger women with a lower ejection fraction and worse functional status. Those using a diary had 35% and 47% more contacts via telephone and clinic, respectively. Both groups had significant functional and B-type natriuretic peptide improvement. If hospitalized after enrollment in the heart failure clinic, average length of stay for all hospital admissions for diary users decreased by 58% (P < .002) and average cost per case decreased by 56% (P < .011). Length of stay and cost per case did not significantly change for those not using diaries. CONCLUSION: Diary users showed evidence of improved clinical and hospital outcomes. Further investigation is needed to clarify the characteristics of a diary user and the effect of diary use on self-management and outcomes.

Assessment of readiness to initiate antiretroviral therapy.

PURPOSE: An important factor in adherence to antiretroviral therapy (ART) is the patient's commitment to follow the regimen, which suggests that therapy should be initiated only when the patient is ready to make such a commitment. Because there has been no research on patient readiness for ART, this study was undertaken to investigate factors that influence the decision of an HIV-positive person to seek medical care and to initiate ART. METHOD: The investigators surveyed 83 HIV-infected patients on ART. Participants completed a questionnaire that obtained information on the length of time from when they learned of their HIV-positive status to when they sought medical care, the length of time from when they learned of their HIV-positive status to when they were ready to initiate therapy, and psychological and social factors thought to be associated with readiness. RESULTS: Respondents had a mean age of 37 years, 71% were male, and 65% were African American. Only 42% said they sought medical care immediately upon learning their HIV diagnosis. Fifty percent were ready to initiate therapy immediately upon learning their diagnosis, and 25% were ready within 1 year. Sixty-four percent of respondents experienced barriers that interfered with therapy initiation. Although 98% of respondents experienced at least one emotional response to HIV diagnosis, less than 25% of respondents thought that their responses interfered with readiness. However, five emotional responses demonstrated an association with readiness through chi-square analysis. CONCLUSION: Further research is needed to explain the relationships among emotional responses to HIV diagnosis, readiness to initiate ART, and adherence.