TY - JOUR
T1 - Facilitators and barriers of heart failure care in Kerala, India
T2 - A qualitative analysis of health-care providers and administrators
AU - Agarwal, Anubha
AU - Davies, Divin
AU - Goenka, Shifalika
AU - Prabhakaran, Dorairaj
AU - Huffman, Mark D.
AU - Mohanan, Padinhare P.
N1 - Publisher Copyright:
© 2019 Cardiological Society of India
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Heart failure
KW - India
KW - Kerala
KW - Qualitative
UR - http://www.scopus.com/inward/record.url?scp=85066782854&partnerID=8YFLogxK
U2 - 10.1016/j.ihj.2019.04.009
DO - 10.1016/j.ihj.2019.04.009
M3 - Article
C2 - 31543196
AN - SCOPUS:85066782854
SN - 0019-4832
VL - 71
SP - 235
EP - 241
JO - Indian Heart Journal
JF - Indian Heart Journal
IS - 3
ER -