Search

Introduction: Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Methods: Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Results: Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. Implications for research: The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians. [ABSTRACT FROM AUTHOR]

Background: Effective heart failure (HF) self-care can improve clinical outcomes but is dependent on patients’ undertaking a number of complex self-care behaviors. Research into the effectiveness of HF management programs demonstrates mixed results. There is a need to improve understanding of patient perspectives’ of self-care need in order to enhance supportive interventions. Aim: This paper reports selected findings from a systematic review of qualitative research related to HF self-care need from the patients’ perspective. The focus here is on those facets of patient-healthcare professional relationships perceived by patients to influence HF self-care. Method: We searched multiple healthcare databases to identify studies reporting qualitative findings with extractable data related to HF self-care need. Joanna Briggs Institute systematic review methods were employed and recognized meta-synthesis techniques were applied. Critical realist theory provided analytical direction to highlight how individual and contextual factors came together in complex ways to influence behavior and outcomes. Results: Altogether 24 studies (1999–2012) containing data on patient-healthcare professional relationships and HF self-care were included. Interaction with healthcare professionals influenced self-care strongly but was notably mixed in terms of reported quality. Effective HF self-care was more evident when patients perceived that their healthcare professional was responsive, interested in their individual needs, and shared information. Poor communication and lack of continuity presented common barriers to HF self-care. Conclusion: Interactions and relationships with clinicians play a substantial role in patients’ capacity for HF self-care. The way healthcare professionals interact with patients strongly influences patients’ understanding about their condition and self-care behaviors. [ABSTRACT FROM AUTHOR]