Document Detail

Multisite randomized trial of a single-session versus multisession literacy-sensitive self-care intervention for patients with heart failure.
MedLine Citation:
PMID:  22572916     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Self-care training can reduce hospitalization for heart failure (HF), and more intensive intervention may benefit more vulnerable patients, including those with low literacy.
METHODS AND RESULTS: A 1-year, multisite, randomized, controlled comparative effectiveness trial with 605 patients with HF was conducted. Those randomized to a single session received a 40-minute in-person, literacy-sensitive training; the multisession group received the same initial training and then ongoing telephone-based support. The primary outcome was combined incidence of all-cause hospitalization or death; secondary outcomes included HF-related hospitalization and HF-related quality of life, with prespecified stratification by literacy. Overall, the incidence of all-cause hospitalization and death did not differ between intervention groups (incidence rate ratio, 1.01; 95% confidence interval, 0.83-1.22). The effect of multisession training compared with single-session training differed by literacy group: Among those with low literacy, the multisession training yielded a lower incidence of all-cause hospitalization and death (incidence rate ratio, 0.75; 95% confidence interval, 0.45-1.25), and among those with higher literacy, the multisession intervention yielded a higher incidence (incidence rate ratio, 1.22; 95% confidence interval, 0.99-1.50; interaction P=0.048). For HF-related hospitalization, among those with low literacy, multisession training yielded a lower incidence (incidence rate ratio, 0.53; 95% confidence interval, 0.25-1.12), and among those with higher literacy, it yielded a higher incidence (incidence rate ratio, 1.32; 95% confidence interval, 0.92-1.88; interaction P=0.005). HF-related quality of life improved more for patients receiving multisession than for those receiving single-session interventions at 1 and 6 months, but the difference at 12 months was smaller. Effects on HF-related quality of life did not differ by literacy.
CONCLUSIONS: Overall, an intensive multisession intervention did not change clinical outcomes compared with a single-session intervention. People with low literacy appear to benefit more from multisession interventions than people with higher literacy.
CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT00378950.
Darren A DeWalt; Dean Schillinger; Bernice Ruo; Kirsten Bibbins-Domingo; David W Baker; George M Holmes; Morris Weinberger; Aurelia Macabasco-O'Connell; Kimberly Broucksou; Victoria Hawk; Kathleen L Grady; Brian Erman; Carla A Sueta; Patricia P Chang; Crystal Wiley Cene; Jia-Rong Wu; Christine D Jones; Michael Pignone
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-05-09
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-12     Completed Date:  2012-08-23     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2854-62     Citation Subset:  AIM; IM    
Division of General Internal Medicine, University of North Carolina School of Medicine, 5041 Old Clinic Bldg, CB#7110, Chapel Hill, NC 27599, USA.
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MeSH Terms
Educational Status
Emergency Service, Hospital / utilization
Heart Failure / mortality*,  psychology,  rehabilitation*
Hospital Mortality
Hospitalization / statistics & numerical data
Middle Aged
Patient Education as Topic / methods*,  statistics & numerical data
Patient Readmission / statistics & numerical data
Quality of Life*
Self Care / methods*,  statistics & numerical data
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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