Developing an Evaluation Plan and Disseminating Results - Research Proposal Example

? Developing an Evaluation Plan and Disseminating Results Affiliation with more information about affiliation, research grants, conflict of interest and how to contact Developing an Evaluation Plan and Disseminating Results For the success of any project, implementation of the recommendations and solutions derived after thorough research into the subject is the key. Incorporating these suggestions through necessary structural, environmental and infrastructural changes can give an impetus to this success plan but then how can these changes be brought about with all the difficulties underlying it? The general apathy for everyone is the attitudinal shift one has to make to adjust in acceptance of these changes as the tendency to seek new avenues is difficult and stressful on the persons and institutions involved. But overcoming these hurdles will always give the satisfaction these changes usher in. Thus, it can be safely sound applying the above concept in the case of CHF patients whose major issue is non-compliance to physicians and preventive treatments that becomes a major stumbling block in combating this fatal disease. So formulating an implementation program to give the best care and medical treatment to such chf patients become imperative with active co-operation from all quarters involved. The role of organizations, medical experts, doctors, nurses, family and society in general has to be defined clearly and with clarity so that it can take a smooth course. Some of the ways to implement successful means to achieve this objective is discussed below. This major hurdle in efficient management of Population, Intervention, Comparison, Outcome and Time (PICOT) occurs mainly due to lack of awareness and noncompliance by patients of the physician’s instructions and medical regimen. “It is also worthwhile at this stage to determine the types of study designs to include in the review; PICOT” (Unit Five: Asking an Answerable Question, n.d., p. 19). There is overwhelming evidence to support this theory and the reasons cited like ignorance and lack of understanding to recognize the signs and symptoms of chf patients, strategic failure in encouraging patients to adhere to medication and treatment in overcoming the maladies of non-compliance which itself is shaping into a dangerous disease, and how the medical community and society with its healthcare professionals can overcome the laxity of expertise into the subject experienced, leading to improvisation. Therefore the proper course of action is by implementing the much wanted changes. First and foremost priority has to be given in seeking ways for identifying the signs and symptoms associated with the chf syndrome, and after much deliberation it was safely concluded that facilitating a checklist which clearly specifies the signs and symptoms will go a long way to eradicate the trust deficit faced by patients and cause non-compliance as suggested in the article “Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?” (Albert, 2012). The results indicated that this methodology boosts the confidence of patients, shedding their reluctant attitudes and raising the compliance level to a better degree Hence it would facilitate for appropriate decisions by care providers for a better overall outcome. “The checklist format prompted patients to report all signs and symptoms they were experiencing, rather than only those they thought were related to heart failure” (Albert et al. 2010). Various cause for non compliance which include factors like demographic indicators, the regimens of medication like side effects or the complexity associated with them, psychological problems, social and family attitudes as well as their concepts about self esteem becomes serious impediments in effectively combating the disease. In this scenario, there is a high relevance for compliance related interventions. The study, stresses the importance of this vital aspect. Here the findings suggest that educating patients before discharge can lead to lessening of readmission, it promotes self-care and patients can identify problems early. There should be active participation by patients in their health management where they can learn about their conditions and medication and when medical treatments have to be availed. It also discusses the need for nurses to understand the hurdles to self-care and help patients to cross these barriers. In another study it was noticed that when the heart is not able to pump adequate blood to meet body needs, it leads to an “exacerbation on the effect of blood pressure, lungs and bodily fluid retention” (Chandler, 2010). The finding of the Merck Manual, found heart failure affects the life of 1 out 100 people, causing sudden death. Treatment and change in lifestyle can help a person overcome this hazard and live longer. Thus, proper compliance to symptoms recognition can have several positive outcomes in the treatment of HF. The United States where primarily 300,000 deaths occur each year with nearly 5 million people prone to CHF, study into a health plan showed that this killer disease was the 20th most prevalent condition of its commercial population and third in its senior population This had a high impact on government expenditure with a major chunk going into management of CHF. Data showed 515 admissions and 3270 inpatients days per 1000 members with CHF per year in comparison to only 35 admissions and 151 inpatient days per 1000 members for non-CHF patients. The results showed that an effective intervention in managing CHF was the use of multidisciplinary health management programmes. “These programs significantly reduced recurrent hospitalizations and utilization of services while improving patient health status, quality of life, and compliance with medications and diet” (Focus on Cardiovascular Diseases, 2012). Lately another strategy adopted to adhere to compliance is through telephonic interventions. Long termed results shown after telephonic intervention in CHF, the purpose being the study to assess the rate of death and hospitalization for HF in a randomized trial of telephonic intervention (DIAL) to improve compliance and knowledge in stable patients. It was observed that there was sustained benefit in the intervention period during and 1 to 3 years succeeding the end of intervention. This was mainly affected by the educational interventional impact on patient’s behavior and habit. For successful treatment of CHF it was assessed that self management with proper consultation behavior was essential. A notable challenge of non adherence with medical regimen in HF can become a major cause for non favorable results translated into the real world, associated with several therapies evaluated in clinical trials. “The greater the complexity of the scheduling, the greater the error of commission and scheduling misconceptions” (Hulka et al. 2012). This has a complex influence and poor net results are associated with it. “Proposals for improvement of drug taking behavior such as in hospital initiation of therapy, dosing regimens simplified through a combination and long acting formulation being adopted and improvement in provider-patient communication is on the review” (Hauptman, 2008). Compliance which is part of individual behavior, in concordance with care instructions and suggestions is associated with ability to maintain behavior associated with care plan embracing complete use of medications, presence at pre-set programmes and proper follow-up .leading to necessary change. According to Lehane & McCarthy, despite plenty of research in last 5 decades little progress in compliance has taken place to solve the problem. Study of results of research conducted showed that 30 to 50% medication was not used as per prescription leading to non effectiveness of drugs with worsening effects leading to a costlier health care regimen. Dwelling further into the subject, a study conducted by Tehran University of Medical Sciences, to explore compliance concepts and recurring factors of non compliance in readmitting patients with HCF The result found was, any unscientific action to establish ‘well being’ was taken as proof of compliance by patients, and applied as a strategic solution to feel ‘providing comfort in daily life’. The suggestion was, ways to use qualitative research could determine compliance definitions and non compliance predisposing factor, with complete revelations before patients discharge so that readmissions could be minimized and avoided. “By engaging their involvement in these knowledge item could be in various methods such as written (e.g., discharge summary, education brochures) and verbal (e.g., one on one, phone calls)” (Problem: How to Deliver Understandable Knowledge of Health – Failure Recovery Practice in Order to Get the Patients Engage Actively, n.d.). An in depth investigation of patients, family, nurses and physicians could throw more light and insight towards this disposing factors and educating them with the compliance concept of “self treatment for sense of wellbeing” (Hekmatpou et al. 2009). This could lay the foundation for decision making and planning care for therapeutic strategies and reducing readmission rates. “These positive outcomes included lower total and heart failure rehospitalization rates, fewer hospital days, improved quality of life and functional status, and lower healthcare costs despite the increased cost of the programs” (Grady et al. 2012). In a study conducted to know the impact of care at a multidisciplinary specialized outpatient congestive heart failure clinic compared with standard care, randomly 230 eligible patients who had experienced an acute episode of congestive heart failure to standard care was assessed with follow up at a multidisciplinary specialized heart failure outpatient clinic. The results showed “Compared with usual care, care at a multidisciplinary specialized congestive heart failure outpatient clinic reduced the number of hospital readmissions and hospital days and improved quality of life “(Doyon et al. 2012). Medical fraternity holds the view that non compliance too has spread like a silent epidemic needing immediate intervention to arrest this issue that aggravates the sufferings of the patients. As a potent intervention platform Internet based treatment is fast gaining importance. This internet treatment can be manipulated with ease to assess attitudes and beliefs of patients regarding treatment conditions in an automatic manner to customize content and treatment supported interventions. This can have a multifaceted effect on compliance related matters like dosage regimen instructions given through phone or mobile platforms, automated routine schedules to be prescribed to treatment reminders, tools for interactive self monitoring questions and concerns, to elicit family support and tailor-made educational programmes for conditional treatments. Results suggest that “web based education and case management has better responses than traditional office based management (Chan, Rasmussen LM)” (Cerretani, 2007). Another reason cited for increase in non compliance stems from affiliation of chronic diseases and the high costs incurred on the treatment Hospitalization and readmissions multiplying patient’s burdens. Tele health care and telemonitoring systems can have a cascading effect in breaking this ‘frequent fliers’ syndrome. Overcoming the high costs involved by early detection and intervention. According to Brookings Institution’s Report, ‘Remote monitoring of CHF patients could save substantially the costs incurred’ (Litan, 2008). The report recommends that telemonitoring and telehealth care can provide improved levels of patient outcome and eradicate non compliance with early intervention, helping reduce readmissions and create health care infrastructure ushering quality home disease management. Depression which negatively influences CHF patient’s pathological mechanisms and behavioral process can be a cause of non compliance by patients. A multidisciplinary team comprising of cardiologists, psychiatrists and hospital or community nurses in mutual consultation and interactions can bring improvement in nursing and medical care conditions. Careful planning, execution and evaluation of medical intervention to implement lifestyle changes beneficial to the patients overall healthy outcome. Thus depressive non compliance traits of CHF patients who are prone to “sedentary life, less compliant to diet and treatment and an inclination to more consumption of alcohol and tobacco can be checked” (Mastrogiannis & Giamouzis, 2012). An exhaustive analysis of the finding gleaned from the above studies point to the fact that non-compliance to the medical norms and physician’s advice can lead to recurrent hospitalization of CHF patients and undermine preventive medicine and treatment by physicians and health care professionals. Thus proper management and recommendations to implement some of the suggestions stated can become benevolent though challenging. If the conclusion of these studies and suggestions are accorded due priority and utmost importance then the medical fraternity can aspire to evolve better solutions to deal with CHF patients. Reference List Albert, N. et al. (2010). Signs and Symptoms of Heart Failure: Are You Asking the Right Questions? AJCC American Journal of Critical Care. Retrieved from http://www.aacn.org/WD/CETests/Media/A101905.pdf Albert, N. M. (2012). Fluid Management Strategies in Heart Failure. American Association of Critical-Care Nurses. Vol. 32. Retrieved from http://ccn.aacnjournals.org/content/32/2/20.full.pdf Chandler, S. (2010). What are Heart Failure Exacerbations? Live Strong. com. Retrieved from http://www.livestrong.com/article/200385-what-are-heart-failure-exacerbations/ Cerretani, J. (2007). Patient Non-adherence-Pervasiveness, Drivers, and Interventions. Sciences. Spotlight Series. Retrieved from http://www.therenalnetwork.org/services/resources/AdherenceToolkit/Herriman_spotlight0807.pdf Doyon, O. et al. (2012). Impact of Care at a Multidisciplinary Congestive Heart Failure Clinic: A Randomized Trial. CMAJ. Retrieved from http://www.cmajopen.com/content/173/1/40.full Focus on Cardiovascular Diseases. (2012). NCQA. Retrieved from http://www.qualityprofiles.org/leadership_series/cardiovascular_disease/cardiovascular_improvingoutcomes.asp Grady, K. L. et al. (2012). AHA Scientific Statement. Retrieved from http://circ.ahajournals.org/content/102/19/2443.1.full Hauptman, P. J. (2008). Medication Adherence in heart Failure. Springer. Vol. 13. Retrieved from http://link.springer.com/article/10.1007%2Fs10741-007-9020-7?LI=true Hekmatpou et al. (2009). Non-Compliance Factors of Congestive Heart Failure Patients Readmitted in Cardiac Care Units. IJCCN. Vol. 2. Retrieved from http://www.inhc.ir/browse.php?a_id=40&slc_lang=en&sid=1 Hulka, B. S. et al. (2012). Communication, Compliance, and Concordance between Physicians and Patients with Prescribed Medications. American Journal of Public Health. Retrieved from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.66.9.847 Litan, R. (2008). An Overview of Home Telehealth: Clinical Outcomes from Telemonitoring Studies. Philips Telehealth Solutions. Retrieved from http://www.cahsah.org/documents/481_philips_telehealth_outcomes.pdf Mastrogiannis, D. & Giamouzis, G. (2012). Depression in Patients with Cardiovascular Disease. Cardiology Research and Practice. Hindawi Publishing Corporation. Retrieved from http://www.hindawi.com/journals/crp/2012/794762/ Problem: How to Deliver Understandable Knowledge of Health – Failure Recovery Practice in Order to Get the Patients Engage Actively. (n.d.). Retrieved from http://www.hsi.gatech.edu/rebo/images/a/a8/Tania-paper.pdf Unit Five: Asking an Answerable Question, (n.d.). Retrieved from http://ph.cochrane.org/sites/ph.cochrane.org/files/uploads/Unit_Five.pdf Read More