Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study.

Prinu Jose,Sanjay Ganapathi,Elizabeth C Rhodes,Linju M Joseph,Ranjana Ravindranath,Panniyammakal Jeemon,Sivadasanpillai Harikrishnan

doi:10.12688/wellcomeopenres.16365.2

Abstract

Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients' motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients' health status were important enablers of high-quality care. Health care providers' advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients' self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.

Highlights

Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population
Study themes We identified a total of nine themes relating to the barriers and facilitators of HF care, which were grouped into patient, caregiver and Health Care Providers (HCPs) levels
High patient caseload during physician consultations, non-adherence to Guideline Directed Medical Therapy (GDMT) and lack of clear self-management care plans are recognized as important barriers to optimal HF care

Summary

Introduction

Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). High patient loads often limited the time health care providers had to provide advice on self-management options. India accounts for a major share of the global burden of HF with an estimated 4 million cases, and unlike many individuals with HF from high-income countries, Indian adults are often affected in their most productive years of life.

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