Akshay Pendyal1, Marjorie S Rosenthal2, Erica S Spatz3, Alison Cunningham4, Dawn Bliesener5, Danya E Keene6. 1. Novant Health Heart and Vascular Institute, Presbyterian Medical Center, 1718 E. 4th Street, Charlotte, NC 28204, USA; National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA. Electronic address: apendyal@novanthealth.org. 2. National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Department of Pediatrics, Yale School of Medicine, PO Box 208064, New Haven, CT 06520-8064, USA. 3. Center for Outcomes Research and Evaluation, Yale School of Medicine, 1 Church Street, New Haven, CT 06510, USA; Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA. 4. Columbus House Inc., PO Box 7093, New Haven, CT 06519, USA. 5. Community partner, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA. 6. National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-0834, USA.
Abstract
BACKGROUND: Outpatient heart failure (HF) care involves intensive self-management (SM). Effective HF SM is associated with improved outcomes. Homelessness poses challenges to successful SM. OBJECTIVES: To identify the ways in which homelessness may impede successful SM of HF and engagement with the healthcare system. METHODS: We conducted open-ended, semi-structured interviews with homeless adults with HF. Data were analyzed by a multidisciplinary team using a grounded theory approach. RESULTS: We interviewed 19 participants, 11 (58%) of whom were homeless at the time of interview. Interviews revealed a combination of influences on HF SM. Major themes included instability and lack of routine, tradeoffs between basic necessities and HF SM, and stigmatization by healthcare providers. CONCLUSIONS: Anticipatory guidance aimed at the unique challenges faced by homeless individuals with HF may aid successful SM. HF providers should simlpify medication regimes and engage in non-stigmatizing discourse. Larger-scale interventions include the creation of medical respite programs.
BACKGROUND: Outpatient heart failure (HF) care involves intensive self-management (SM). Effective HF SM is associated with improved outcomes. Homelessness poses challenges to successful SM. OBJECTIVES: To identify the ways in which homelessness may impede successful SM of HF and engagement with the healthcare system. METHODS: We conducted open-ended, semi-structured interviews with homeless adults with HF. Data were analyzed by a multidisciplinary team using a grounded theory approach. RESULTS: We interviewed 19 participants, 11 (58%) of whom were homeless at the time of interview. Interviews revealed a combination of influences on HF SM. Major themes included instability and lack of routine, tradeoffs between basic necessities and HF SM, and stigmatization by healthcare providers. CONCLUSIONS: Anticipatory guidance aimed at the unique challenges faced by homeless individuals with HF may aid successful SM. HF providers should simlpify medication regimes and engage in non-stigmatizing discourse. Larger-scale interventions include the creation of medical respite programs.
Authors: David J T Campbell; Helen Tam-Tham; Kirnvir K Dhaliwal; Braden J Manns; Brenda R Hemmelgarn; Claudia Sanmartin; Kathryn King-Shier Journal: Circ Cardiovasc Qual Outcomes Date: 2017-01
Authors: Al Richmond; Sergio Aguilar-Gaxiola; Eliséo J Perez-Stable; Usha Menon; Chanita Hughes-Halbert; Karriem S Watson; Regina Greer-Smith; Courtney Clyatt; Jonathan N Tobin; Consuelo H Wilkins Journal: BMC Proc Date: 2019-04-19