Facilitators and barriers of heart failure care in Kerala, India: A qualitative analysis of health-care providers and administrators

被引：9

作者：

Agarwal, Anubha ^{[1
]}

Davies, Divin ^{[2
]}

Goenka, Shifalika ^{[3
,4
]}

Prabhakaran, Dorairaj ^{[3
,4
]}

Huffman, Mark D. ^{[1
,5
,6
]}

Mohanan, Padinhare P. ^{[2
]}

机构：

[1] Northwestern Univ, Dept Med, Feinberg Sch Med, Chicago, IL 60611 USA

[2] WestFt Hitech Hosp Ltd, Trichur, Kerala, India

[3] Ctr Chron Dis Control, Delhi, India

[4] Publ Hlth Fdn India, Gurugram, Haryana, India

[5] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA

[6] George Inst Global Hlth, Sydney, NSW, Australia

来源：

INDIAN HEART JOURNAL | 2019年 / 71卷 / 03期

基金：

美国国家卫生研究院;

关键词：

Heart failure; India; Kerala; Qualitative; CARDIOVASCULAR-DISEASE; EPIDEMIOLOGY; MEDICINES; OUTCOMES; WORLD;

D O I：

10.1016/j.ihj.2019.04.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: Heart failure is a leading cause of death worldwide and in India, yet the qualitative data regarding heart failure care are limited. To fill this gap, we studied the facilitators and barriers of heart failure care in Kerala, India. Methods and results: During January 2018, we conducted a qualitative study using in-depth, semi-structured interviews with 21 health-care providers and quality administrators from 8 hospitals in Kerala to understand the context, facilitators, and barriers of heart failure care. We developed a theoretical framework using iteratively developed codes from these data to identify 6 key themes of heart failure care in Kerala: (1) need for comprehensive patient and family education on heart failure; (2) gaps between guideline-directed clinical care for heart failure and clinical practice; (3) national hospital accreditation contributing to a culture of systematically improving quality and safety of in-hospital care; (4) limited system-level attention toward improving heart failure care compared with other cardiovascular conditions; (5) application of existing personnel and technology to improve heart failure care; and (6) longitudinal and recurrent costs as barriers for optimal heart failure care. Conclusions: Key themes emerged regarding heart failure care in Kerala in the context of a health system that is increasingly emphasizing health-care quality and safety. Targeted in-hospital quality improvement interventions for heart failure should account for these themes to improve cardiovascular outcomes in the region. (C) 2019 Cardiological Society of India. Published by Elsevier B.V.

引用

页码：235 / 241

页数：7

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