Investigating the impact of a nurse-led structured automated telephone support intervention on adherence to self-management for patients with heart failure: the Fairfield Adherence Study

Patients recruited will be those eligible to receive ongoing care in the community through the Fairfield Heart Failure Service following discharge from Fairfield Hospital for a cardiac admission and referral to the heart failure (HF) Service. Patients are initially contacted by a member of the HF Service within 1-2 weeks of their discharge from Fairfield Hospital. After eligibility for the Fairfield HF Service has been established and the patient consents to receive the service, the HF nurse arranges an initial home visit at a mutually convenient time. During this home visit the HF nurse conducts a comprehensive assessment of the patient and their clinical, educational and psycho-social situation and needs. This initial assessment usually takes 1-1.5 hrs. A plan of care will be established, mapping how these needs will be addressed and met. This will include provision of HF self-care education. A maintenance and monitoring program will be agreed, whereby there will be telephone or home visit contact usually from a nurse on an agreed frequency, tailored on an ongoing basis to the patient’s needs at the time. For patients allocated to receive the intervention of this study, this ongoing contact will derive from telephone calls to the participant's personal number (landline or mobile) of a conversational robot program primed with scripted content comprised of monitoring questions intended to differentiate patients who are currently effectively self-managing their HF from those who need more detailed assessment and/ or some form of clinical input - an automated structured telephone support program (ASTS program) . Questions have been designed so that, if the patient is experiencing a problem with self-management, their responses will flag this. Monitoring questions include asking: * Have you weighed yourself in the last 3 days? * Since we last talked, have you been able to stick to your prescribed fluid restriction? * Since we last talked, have you been able to stick to your prescribed salt restriction? * Since we last talked, have you experienced any difficulty breathing or shortness of breath? * How many pillows do you currently use at night? Have you increased or reduced the number of pillows you use recently? What change did you make, and when? * Since we last talked, have you experienced any episodes of fast or irregular heart rate or palpitations? * Have you experienced any chest pain? * Since we last talked, have you experienced any swelling in your ankles or legs? * In the last week, has there been any changes to the medications you are taking or any missed doses? These include flagging questions which trigger alerts to the HF Service staff. Prompts follow each question, designed to tease out salient details in relation to responses. The anticipated timing of the first telephone contact is within 1-2 weeks of the assessment home visit and it is anticipated that, whilst the frequency of initial telephone contacts is a clinical decision to be made, and if necessary revised, by the HF Service staff, phone contacts will predominantly occur weekly and be continued for a period of three months. The ASTS program follows a routine whereby the patient first receives an SMS to their mobile phone alerting them to a phone call in 15 min time. If the patient does not answer this call, a second call will be initiated 5 hrs after the first. If the patient does not answer this, a third call will follow 24 hrs later. If the patient does not answer this, a second SMS will alert the patient that they have missed 3 calls. All calls will be initiated between 9am - 5pm, Monday to Friday. They will then have a period of 2 days to initiate a response call to the sending number. Programmed telephone responses will be monitored by HF Service staff and, where indicated, followed up by the HF Clinical Nurse Specialist (CNS) with a phone call/ home visit as required. The scripted content has been developed based on the questions included in local nurses’ routine monitoring phone conversations, previous experience locally using similar programs for home monitoring of chronic obstructive airways disease patients and other patient groups (Chow et al., 2023; Chow et al., 2018; Chow et al., 2019), discussions with local consumers and examples from published studies such as Angermann et al. (2012), Baker et al. (2005) and Barth (2001). The draft program was discussed and piloted in consultation with community-living consumers with HF. These conversations will be audio-recorded so that Fairfield Heart Failure clinical staff can review them. As for routine care, the frequency of contact will be determined as part of the initial plan of care, and reviewed / revised on an ongoing basis in light of telephone responses to questions. As for routine care, patients will have a telephone number for the Fairfield Heart Failure Service, so they will be able to make contact with a healthcare professional if they need to talk to someone, have unanswered questions or a problem that they have not been able to raise in a regular contact. Adherence to the ASTS program will be monitored through the program, in terms of calls answered, responding to questions, call frequency and duration. The program is maintained on a software platform property of 'Curious Thing, AI Contact Automation' which provides a portal for the research and clinical team members to login to view details of each call and of the progress of the intervention as a whole.