Impact of pharmacist-led heart failure tool kits on patient-reported self-care behaviors in a primary care-based accountable care organization.

Objective: The goal of this project is to evaluate the impact of a pharmacist-led heart failure (HF) intervention, using an educational toolkit, on patient-reported self-care maintenance, management, and confidence at 30 days.

Setting: Three Accountable Care Organization (ACO) primary care provider offices in South Florida from January to March 2018.

Practice Description: Each primary care clinic was staffed with at least 1 physician, nurse practitioners, a clinical pharmacy faculty member, pharmacy residents and students, and ancillary staff. Pharmacists spent approximately 2 days per week in clinic.

Practice Innovation: At the time of this project, no formalized management program for HF patients existed within the clinics. An educational toolkit was designed, reviewed, and approved by the team of pharmacists and ACO providers before use within the clinics, and included educational material outlining common causes of HF exacerbation, symptoms of HF, symptom management strategies, medication action plan, self-management instructions, medication adherence tips, and a weight-management log sheet.

Evaluation: A prospective, pretest and posttest observational project was conducted at the 3 clinical sites for eligible patients. The Self-Care for Heart Failure Index (SCHFI, v.6.2) tool was used to evaluate self-care practices and adequacy of maintenance, management, and confidence at baseline as compared with 30 days.

Results: Twelve participants completed the initial interview and 30-day follow-up. SCHFI scores for self-maintenance (63-68, P = 0.04) and self-management (38-58, P = 0.01) significantly improved from baseline, whereas self-confidence scores showed an increase, but was not statistically significant (80-82, P = 0.58). All self-care behaviors saw a nonstatistically significant improvement in percentage of patients achieving adequacy.

Conclusion: Pharmacists and educational toolkits in the ACO primary care setting may improve self-maintenance, self-management, and self-confidence behaviors in patients with HF.