The Application Of Peer Support In Self-Care Of Patients With Chronic Heart Failure

Purpose:To evaluate the effect of peer support intervention on improving self-care, six minutes walking test results, emergency-visit, readmission, anxiety and depression of patients with chronic heart failure.Methods:A controlled cluster prospective trial was used in this study. Communities were selected in July 2015 and then randomized into the peer support group and control group, which are within the jurisdiction of Mofan Road and Changjiang Community Health Center. The sample contained 136 patients with chronic heart failure who lived in the research communities and met the inclusion criteria, and were divided into two subgroups. The control group (n=68) only received self-care health education. The peer support group (n=68) were given self-care health education and peer support for 3 months. The peer support intervention included the training and assessment of peer leaders, the establishment of peer leader-patient group and peer support activities, such as peer leader-patient communication, face-to-face activities and peer home. The Self-Care of Heart Failure Index (SCHFI) was used to measure patients'self-care behavior. The 6-minute walking test (6-MWT) was used to evaluate cardiac function classification. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression situation. At the same time, the patient's emergency-visit rate, readmission rate and readmission time due to heart failure were recorded. All data were collected at baseline and 3 month, in order to evaluate the effectiveness and feasibility of peer support to improve research indicators of patients with chronic heart failure.Results1.A total of 130 subjects completed all data collection,66 cases of the peer support group and 64 cases of the control group. No significant differences were found between two subgroups at baseline (P>0.05).2.At 3 months, the self-care total score, self-care maintenance score and self-care management score of peer support group were significantly higher than that of the control group(P<0.01). The HADS.A score of peer support group was significantly lower than that of the control group(P<0.05). There were no differences in other indicators(P>0.05).3.Compared to baseline, the self-care total score, self-care maintenance score and self-care management score of peer support group were statistically siginificant(P< 0.001).The readmission rate of peer support group after the intervention was siginificantly lower than that of peer support group before the intervention(12.12% VS 27.28%, P<0.05). At 3 months, the HADS.A score of peer support group was siginificantly lower than before the intervention(P<0.001).Besides, there were no significant differences in other indicators between after and pre-intervention of peer support group (P>0.05).Conclusions:1.Compared with the control group, peer support can help patients with chronic heart failure to improve self-care maintenance, self care management and overall self-care.2.In this study, peer support failed to improve self-care confidence, and its application effect needs to be further demonstrated.3.In this study, peer support failed to improve the six minute walk test results of patients with chronic heart failure. It is worthy of further research to study whether peer support can improve patients'cardiac function.4.Compared with the control group, peer support can't make patients'emergency-visit rate, readmission rate and readmission time due to heart failure decrease. Whether it can play a role is worth further study.5.Compared with the control group, peer support has some effect on relieve patients' anxiety.Because of the small research sample, the effect of peer support is not obvious.6.In this study, depression can't be relieved by peer support, and its application effect needs to be further demonstrated.