Patients' and nurses' views of nurse-led heart failure clinics in general practice: a qualitative study

Objectives: To ascertain nurses' and patients' views and experiences of a nurse-led heart failure clinic provided in general practice. Methods: The study was set in eight general practices in the North-West of England. Semi-structured interviews were devised and administered, with all the nurses providing the clinics and a purposive sample of patients attending the clinics. The interviews were tape-recorded and transcribed. Constant comparative analysis was used to identify key issues and themes. Results: Nurses felt that the self-care advice provided had empowered patients to manage their condition. Explaining why a medication had been prescribed, and how it controlled heart failure, was felt to increase compliance. Although communication was deemed good, some patients were reticent about asking questions. Patients were knowledgeable about their prescribed heart failure medications, but some did not recall having discussed their medications. Also, medication inserts led some patients to question their prescription. Patients remained confused about the purpose and outcome of investigations. Furthermore, many patients suggested that they had problems adhering to or remembering the advice given. Discussion: There are practical benefits to be obtained from attending a nurse-led heart failure clinic in primary care. However, patients and healthcare providers may have quite divergent views about such a service and its benefits, emphasizing the potential value of consumer involvement and feedback when developing and delivering such services.