Friends, social networks valued by heart failure patients and health care providers

In a study from Kansas and Missouri, researchers sought to understand patients' perceptions of symptoms, and how and when they decide to seek professional care. After interviewing 90 patients, researchers found more than 80 percent said they talked to people from their social networks -- a spouse, life partner, or adult children -- about their symptoms prior to hospitalization.

"Symptoms in chronic illnesses are often subtle in onset, wax and wane over time, and may not be particularly bothersome until patients are acutely ill. So, a symptomatic person might first discuss his or her symptoms with close and trusted people from their social networks -- namely, family members and friends -- to garner their opinions," said Katherine M. Reeder, Ph.D., RN, lead author of the study on heart failure self-management and research assistant professor at Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri.

Researchers also found:

• Most often (76 percent), lay consultants attributed patients' symptoms to heart problems.
• About 77 percent of patients received advice from lay consultants about what to do for symptoms, and in 83 percent of cases that advice was to seek medical care.
• Women consulted with adult children about their symptoms significantly more often than men (48 percent vs. 8 percent).

"Our findings shed light on the importance of patients' interactions with persons from their social network," said Reeder who is also adjunct assistant professor at Kansas University School of Medicine in Kansas City, Kansas. "Better understanding the post-discharge environment context of self-care, including social interactions about health concerns is needed to enhance effectiveness of healthcare provider conversations with patients and families, as well as to optimize self-management interventions, improve outcomes, and reduce hospital readmissions," she said.

In a separate independent study from California, researchers evaluated the Department of Veterans Affairs' Heart Failure (HF) Provider Network, a network of healthcare providers who share heart failure best practices, collaborate and exchange ideas on evidence-based programs, and share resources to improve heart failure care. More than 1,200 multi-disciplinary/multi-level healthcare providers from throughout the VA Health Care System have participated as members of the HF Network. They include leadership from VA Central Office, regional hospitals, chiefs of cardiology, staff physicians, nurses, quality managers, pharmacists, researchers and others. The HF network operates via bi-monthly web-based meetings/conference calls, an annual in-person meeting, emails and web-based surveys.

"Social networks offer an effective platform for the implementation of evidence-based practices to improve the quality of care from local, regional to national levels. Members perceive the social network as a valuable forum for the exchange of both explicit and tacit knowledge regarding effective activities to implement best evidence-based practices and improve clinical care," said Anju Sahay, Ph.D., lead author of the study and Implementation Research Coordinator for the VA Chronic Health Failure QUERI Center in Palo Alto, California.

Researchers gathered 219 survey and 25 interview responses from network members. They found that members participated in the HF Network to stay informed and maintain or enhance their knowledge in heart failure. Researchers also found:

• 90 percent of members reported that the HF Network helped them establish collaborations and/or network among members.
• 63.8 percent of members also reported that their participation in the HF Network provided them with names of contacts for networking and potential problem solving.
• 94 percent of the members found attending the web-based meetings and conference calls helpful in learning about barriers and facilitators in setting up or running HF programs.

Sahay said this social network expands the community of medical practitioners and other providers by offering valuable perspectives that can improve research-based care based on the latest scientific evidence. The HF Network is also used to implement interventions that can lead to improved quality of care.

Researchers said the next step is to understand the concept of a community-of-practice within the social network, then leverage this connectedness to recognize the importance of professional norms, consensus and team care to facilitate shared knowledge and quality improvement for clinical practices.