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Summaries
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Site A
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Site B
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Site C
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| SMA structure & content |
• Content adjusted based on group interest and need |
• Structure is adaptable. |
• Multi-disciplinary |
| • Interactive |
• Set curriculum |
• Individual and group attention |
| • Multidisciplinary |
• Taught like classes, but opportunity for interaction |
• 4 sessions, 1.5 hour |
| • Resources provided to patients |
• Multidisciplinary; |
• Need 4–5 patients to be effective |
| • Individualized care |
• Informational handouts distributed |
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| • Group setting, 8–10 patients |
• Patients get brief exam. |
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| • Patients learn skills. |
• Four different sessions; 1/week |
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| • 2-hour comprehensive & less fragmented appointment |
• Cardiologist oversight |
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| • Provides education for medications & diet |
• Critical for pharmacist to lead |
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| • Skills of leader are critical. |
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| Effect on patients |
• Benefit from sharing knowledge & experiences. |
• learning from each other |
• Patient-to-patient sharing/support |
| • Learn self-management |
• Develop community |
• Most successful SMA patient has support at home and is not a substance abuser or mentally ill/demented |
| • Develop comradery with other patients. |
• Receiving HF education helps with lifestyle change and self-management. |
• Good for newly diagnosed patients |
| • Convenient |
• Helps with medication adherence |
• Efficient use of provider/patient time |
| • Holistic care |
• Helps with emotional response to HF |
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| • Patients become proactive. |
• Validates patient’s experience |
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| • Better care continuity |
• Some patients don’t like groups. |
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| • Perceived decrease in hospital and/or emergency department visits |
• Some patients need more individualized attention. |
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| • Earlier appointments |
• Travel can be a barrier. |
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• Easy access to providers |
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• Not for very ill patients |
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• Study will see how well it works |
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| Suggested improvements |
• Increase number of SMAs |
• Increase number of sessions |
• Add exercise component |
| • Add more providers such as nurse practitioners |
• Add an exercise physiologist |
• Refresher sessions would be helpful to patients |
| • More ‘new’ resources: physical therapist/social worker/ |
• Offer SMAs at outpatient clinics |
• Need good communication between providers |
| exercise physiologist |
• Offer a support group |
• Better for success when SMAs are endorsed by VA administration and/or by cardiology department heads |
| • Offer more SMAs at outpatient clinics (especially rural) |
• Add an advanced class |
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| Longer duration |
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| • Encourage caregiver of patients with cognitive issues to attend |
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| • Add cooking class |
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| Experience of providers |
• Inter-disciplinary knowledge sharing |
• Providers learn from each other. |
• Able to treat patients more holistically through SMAs |
| • Efficient sessions |
• Address issues providers don’t have time for |
• A lot of work for provider but great for patients |
| • Better job satisfaction |
• Not helpful to providers |
• Saves providers time |
| • Learn from patient to patient interactions |
• Reduces redundancy for providers |
• A lot of work |
| • Able to be more holistic with care |
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| • Provides opportunity for more communication between SMA providers and primary care provider (PCP)s |
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| Patient referrals |
• Patients with new onset, existing, acute chronic symptoms or based on chart review are referred. |
• HF inpatients are referred by nurse |
• HF nurse approaches inpatients for immediate consent & scheduling |
| • Nurse Practitioner (NP) or PCP refers. |
• All HF hospitalized patients referred |
• Recruitment is an issue if cardiology department isn’t on-board |
| • HF NP is SMA gatekeeper |
• All HF Consults referred to SMA |
• No direct consult for SMAs |
| • Don’t refer patients who don’t like groups or have severe behavioral or violence issues. |
• PCPs and pharmacist refer |
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| • More direction needed for referrals |
• PCPs can refer patients to specific SMA session |
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| • Distribute more information to patient on SMA pros and cons prior to visit |
• SMA provider is added as signer |
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• number of referrals up since new chief |
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• Streamline referral process |
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