The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review

Background Heart failure is a major health burden worldwide. Patient education is the primary process used to increase knowledge of self-care practices for patients with heart failure. Most education occurs during one-on-one visits between a patient and a health care provider. Group visits with a health care provider and a small group of patients provide an alternative method for providing patient education. The goal of group visits for patients with heart failure would be to increase patient knowledge and self-care abilities, while improving self-efficacy. Objective The objective of this review is to identify the effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care behaviors, and hospital readmissions. Inclusion criteria Types of participants Community-living adult patients (18 years and above) of all races and ethnicities with a diagnosis of heart failure. Types of interventions Group visits for adult patients with heart failure compared to one-on-one provider visits. Types of outcomes Patient knowledge about heart failure, quality of life, self-care behaviors, unplanned readmissions, and emergency room visits. Types of studies Randomized controlled trials, non-randomized controlled trials, and quasi-experimental trials were considered for inclusion. In their absence other qualitative studied designs were considered. Search strategy Published and unpublished studies in the English language were sought from the inception of the included databases through September 2012. The databases searched included: PubMed, CINAHL. Embase, and Health Source: Nursing/Academic edition. A search for gray literature and hand searching of reference lists were also performed. Methodological quality Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection and synthesis Data were extracted using standardized data extraction instruments from the Joanna Briggs Institute. Due to heterogeneity between included studies, statistical pooling was not possible. Results are presented in a narrative form. Results Two pilot studies were included in this review. One study demonstrated an improvement in heart failure knowledge and a trend toward improvement in self-care behaviors. The other study showed improvements in self-care behaviors and depression while reducing the number of hospitalizations. Conclusions The group visit model has the potential for improving knowledge and self-care behaviors, while increasing quality of life and decreasing hospitalizations for patients with heart failure. Implications for practice Clinicians should consider group visits as an alternative method of providing patient-centered care that allows the clinician to see a large number of patients in a short time period while providing education and health management. Implications for research Randomized control trials should be conducted to determine the most effective format and the most effective health care provider team for the group visit model on larger samples of culturally diverse populations across multiple settings. Future research should also seek to determine the most appropriate duration for the group visit appointment.