Location of Repository

The self management of heart failure: a place in practice?

By Jonathan Silcock


BACKGROUND\ud Self management of heart failure has been suggested as a way to prevent hospital admissions. Understanding influences on self management could help to achieve targets\ud for clinical outcomes and patient engagement. The implementation of self management in heart failure appears to be limited compared with other long term conditions. We\ud know little about why this is the case.\ud \ud AIM\ud To identify patients‟ and healthcare professionals‟ knowledge of and attitudes towards self management of chronic heart failure.\ud \ud SETTING AND PARTICIPANTS\ud Twenty-one patients (14 women and 7 men with a mean age of 74) recruited from a general medical practice in an urban area of Leeds, West Yorkshire. Professionals (six\ud doctors, five nurses, five pharmacists and three others) recruited from the local health economy.\ud \ud METHODS\ud Semi-structured interviews were recorded with patients meeting defined inclusion criteria and professionals who cared for them or developed local services. Tapes were\ud transcribed verbatim and thematically coded. Relationships between themes were explored qualitatively using "Framework‟ analysis as a guide.\ud \ud RESULTS\ud Patients‟ activities were restricted in similar ways by symptoms, but only nine had good understanding of their diagnosis. Patients trusted their doctors, but were given few opportunities to learn about their condition and engage with its management. Patients‟ need for explanations, capacity to understand and potential for clinical improvement were probably underestimated. If it was proposed, all patients would monitor and record\ud signs or symptoms to guide variable diuretic dosing. Few patients wished to self adjust doses by protocol, preferring instead to follow direct professional instructions. Few patients felt they could learn from group work with peers: a regular part of self management training. Patients‟ attitudes towards disease management were informed by their interpretation of symptoms, care and daily living. Their greatest priority was continuity of care not having more choice or responsibility. Professionals‟ conceptions of patient self management varied considerably. Specialists tended to support full\ud disclosure and possible self management for a wide variety of patients; whereas generalists were more cautious.\ud \ud CONCLUSIONS\ud Patients who could potentially benefit from self management were not aware of it or given enough opportunities to participate. Patients and professionals should work\ud towards more open discussions about diagnosis, expectations and care

Publisher: School of Healthcare (Leeds)
Year: 2009
OAI identifier: oai:etheses.whiterose.ac.uk:836

Suggested articles



  1. (1992). A comparison of the theory of planned behavior and the theory of reasoned action. doi
  2. (2007). A competency framework for shared decision-making with patients: achieving concordance for taking medicines. Keele:
  3. (2006). A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial.
  4. (2005). A national dissemination of an evidence-based self-management program: a process evaluation study. Patient Education and Counseling, doi
  5. (2001). A qualitative assessment of health related issues of importance in elderly congestive heart failure patients.
  6. (1997). A qualitative investigation into why patients change their GPs. doi
  7. (2002). A qualitative study of chronic heart failure patients' understanding of their symptoms and drug therapy. doi
  8. (2006). A qualitative study of GPs' attitudes to self-management of chronic disease.
  9. (2005). A rapid review of the current state of knowledge regarding lay-led self management of chronic disease. London: National Institute for Clinical Excellence.
  10. (2004). A story of maladies, misconceptions and mishaps: effective management of heart failure. doi
  11. (2007). A survey of general practitioners‟ perceptions of beta-blocker therapy for heart failure.
  12. (2007). A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. doi
  13. (2003). A systematic review of telemonitoring for the management of heart failure. doi
  14. (2008). A systematic review of the use of economic evaluation in local decision-making. doi
  15. (2000). ABC of heart failure: non-drug management. doi
  16. (2003). ABC of learning and teaching in medicine: applying educational theory in practice. doi
  17. (1992). ABC of monitoring drug therapy: patient compliance. doi
  18. (2007). About expert patients. doi
  19. (2009). About Monitor. Retrieved 10th April,
  20. (2009). About us. Retrieved 10th April,
  21. (1999). Acknowledging the expertise of patients and their organisations. doi
  22. (2008). Adherence in heart failure in the elderly: problem and possible solutions. doi
  23. (2006). Adherence to antibiotics: analysis and paralysis. Paper presented at the Health Services Research and Pharmacy Practice Conference.
  24. (2003). Adherence to long term therapies: evidence for action. Geneva: World Health Organisation.
  25. (2006). An integrative model of shared decision making in medical encounters. doi
  26. (2005). An introduction to group work practice (Fifth ed.).
  27. (2009). An introduction to qualitative research doi
  28. (1966). An introduction to social medicine. doi
  29. (2006). An introduction to the collaborative methodology and its potential use for the management of heart failure. doi
  30. (2002). Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. doi
  31. (2007). Approaches to social enquiry: advancing knowledge.
  32. (2004). Assessing the process of embedding EPP in the NHS: preliminary survey of PCT pilot sites. Manchester: National Primary Care Research and Development Centre.
  33. (1996). Audit or research-what is the difference? doi
  34. (2005). Balancing the strengths of systematic and narrative reviews. Human Reproduction Update, doi
  35. (2003). Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. doi
  36. (2004). Barriers to diagnosing and managing heart failure in primary care.
  37. (1999). Barriers to optimum management of heart failure by general practitioners.
  38. (2006). Beyond diuretics: management of volume overload in acute heart failure syndromes. doi
  39. (2006). Can I come off the tablets now?' A qualitative analysis of heart failure patients' understanding of their medication. doi
  40. (2005). Can patients interpret health information? An assessment of the medical data interpretation test. doi
  41. (2003). Case study research: design and methods. Thousand Oaks:
  42. channel blockers and other anti-anginal drugs.
  43. (1952). Chemotherapy of pulmonary tuberculosis in young adults. doi
  44. (2001). Clinical trials. In doi
  45. (2003). Cognitive deficits in patients with heart failure: a review of the literature. doi
  46. (2007). Cognitive impairment in heart failure: a systematic review of the literature. doi
  47. (2005). Commissioning a patient led NHS. London: Department of Health. doi
  48. (2006). Communication in heart failure: perspectives from older people and primary care professionals. Health and Social Care in the doi
  49. (1994). Competing paradigms in qualitative research.
  50. (2006). Compliance in heart failure patients: the importance of knowledge and beliefs. doi
  51. (2005). Concordance, adherence and compliance in medicine taking: report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D.
  52. Congestive heart failure and cognitive impairment in an older population. Osservatorio Geriatrico Campano Study Group.
  53. (2007). Consumer medicines information in the United States, Europe and Australia - a comparative evaluation.
  54. (2008). Coordinating care - a perilous journey through the health care system. doi
  55. (2001). Coping strategies in the selfmanagement of chronic heart failure. Family Practice, doi
  56. (1994). Criteria Committee of the New York Heart Association. doi
  57. (2000). Cultures of care: biographies of carers in Britain and the two Germanies. doi
  58. (1999). Decision making in the physician patient encounter: revisiting the shared treatment decision making model. doi
  59. (1998). Dementia: a serious and enduring mental illness.
  60. (2003). Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. doi
  61. (2000). Development and testing of a clinical tool measuring self-management of heart failure. doi
  62. (2003). Development and testing of the European Heart Failure Self-Care Behaviour Scale. doi
  63. (2003). Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in every-day practice. doi
  64. (2000). Dilemmas in qualitative health research. doi
  65. (2006). Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. doi
  66. (2000). Diuretic use and abuse in systolic cardiac failure: a recipe for renal impairment? doi
  67. (2006). Diuretics in congestive heart failure. In doi
  68. (2008). Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain?
  69. (2000). Doctorpatient communication about drugs: the evidence for shared decision making. doi
  70. (1994). Doing social research. doi
  71. (2004). Dyspepsia: management of dyspepsia in adults in primary care.
  72. (2004). Economics of health care financing: the visible hand.
  73. (2006). Educational Failure Working Group. doi
  74. (1995). Effective physician-patient communication and health outcomes: a review.
  75. (1993). Effects of computer generated reminder charts on patients' compliance with drug regimens. doi
  76. (1998). Elderly patients with heart failure: a study of satisfaction with care and quality of life. doi
  77. (2001). England and Wales, doi
  78. (1999). Epidemiology of heart failure and ventricular dysfunction. doi
  79. (2008). Establishing support groups for HIV-infected women: using experiences to develop guiding principles for project implementation. doi
  80. (1993). Ethical aspects of the doctor-patient relationship.
  81. (2002). European Society of Cardiology. doi
  82. (2000). European survey of primary care physician perceptions on heart failure diagnosis and management (Euro-HF). doi
  83. (1992). Evidence Based Medicine Working Group. doi
  84. (2000). Evidence based medicine: how to practice and teach EBM.
  85. (2008). Evidence for the impact of quality improvement collaboratives: systematic review. doi
  86. (1993). Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing care costs. doi
  87. (2000). Evidence-based pharmacy. doi
  88. (2000). Exercise and older patients: guidelines for the clinician.
  89. (2008). Experiences of living with congestive heart failure: a qualitative study. doi
  90. (2007). Exploring adherence to cardiovascular medicines.
  91. (2002). Facilitators and barriers to heart failure self-care. doi
  92. (2008). Factors influencing medication adherence in patients with heart failure. doi
  93. (1999). Factors influencing patient compliance with therapeutic regimens in chronic heart failure: a critical incident technique analysis. doi
  94. (1996). Farewell to criteriology. doi
  95. (2000). Fear of change? A myth! doi
  96. (2006). Five misunderstandings about case study research. doi
  97. (2003). for Chronic Conditions. doi
  98. (2007). for Mental Health. doi
  99. (1989). Fourth generation evaluation. doi
  100. (2003). From best evidence to best practice: effective implementation of change in patients' care. doi
  101. (1998). From compliance to concordance: achieving shared goals in medicine taking.
  102. (2008). from http://lse.ac.uk/collections/LSEHealthAnd SocialCare/documents/ByProfessorJulianLeGrand.pdf
  103. (2009). from http://www.cqc.org.uk/aboutcqc.cfm
  104. (2008). from http://www.dh.gov.uk/en/aboutus/ministersanddepartment leaders/chiefmedicalofficer/progressonpolicy/progressbrowsabledocument/dh_4102757 Christakis,
  105. (2009). from http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/index.htm Department of Health. (2009c). Long term conditions.
  106. (2008). from http://www.ic.nhs.uk/services/qof The OECD Health Project.
  107. (1994). Functional ability of patients to manage medication packaging: a survey of geriatric inpatients. doi
  108. (1998). Functional status and depression among men and women with congestive heart failure. doi
  109. (1989). Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. doi
  110. (2007). GP list sizes in England. Newcastle: Prescription Pricing Authority. Available from http://www.ppa.org.uk/foidocs/responses/FOI_Request(344010).pdf
  111. (2007). Group and General Practitioners Committee.
  112. (2005). Guidelines for the diagnosis and treatment of chronic heart failure: full text (update
  113. (2005). Health lifestyle theory and the convergence of agency and structure. doi
  114. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies in the 21st century. doi
  115. (2002). Health literacy: new wine in old bottles. doi
  116. (2000). Health Literacy. Current Bibliographies
  117. health outcomes: a systematic review of the literature. doi
  118. (2005). Heart failure and health related quality of life. doi
  119. (2002). Heart failure in primary care: qualitative study of current management and perceived obstacles to evidencebased diagnosis and management by general practitioners. doi
  120. (2004). Heart failure patient learning needs after hospital discharge. doi
  121. (2008). Heart failure service for the management of chronic heart failure. doi
  122. (1995). Heart failure: evaluation and care of patients with left ventricular systolic dysfunction. doi
  123. (2005). Heart failure. doi
  124. (2000). Heart Messages: a tailored message intervention for improving heart failure outcomes. doi
  125. (2009). Helping to Provide High Quality Care in Primary Care.
  126. (2008). High quality care for all: NHS next stage review final report (Cm 7432). London: The Stationary Office.
  127. (2005). Hope and autonomy in the context of heart transplantation.
  128. (2007). How do patients use medicine information leaflets in the UK? doi
  129. (2000). How to improve communication between doctors and patients. Learning more about the decision making context is important.
  130. (1997). Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. doi
  131. (2008). Impact of health literacy on health outcomes in ambulatory care patients: a systematic review. doi
  132. (2005). Improving medication knowledge among older adults with heart failure: a patientcentered approach to instruction design. doi
  133. (2007). Improving patient care by linking evidencebased medicine and evidence-based management. doi
  134. (1996). Improving patient education for patients with low literacy skills.
  135. (2001). Influence of context effects on health outcomes: a systematic review. doi
  136. (2006). Interpreting qualitative data (Third ed.). doi
  137. (2000). Interpretivism and Generalisation. doi
  138. (2007). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, doi
  139. (2005). Intrathoracic impedance monitoring in patients with heart failure correlation with fluid status and feasibility of early warning preceding hospitalization. doi
  140. (1995). Introduction to research in the health sciences (Third ed.).
  141. (2000). Introduction. In doi
  142. (2001). Is it denial or wisdom to accept life threatening illness? doi
  143. (2000). Knowledge and communication difficulties for patients with chronic heart failure: qualitative study. doi
  144. (1998). Learning needs of congestive heart failure patients.
  145. (2003). Life with a rare chronic disease: the scleroderma experience. doi
  146. (2009). Life: a medical condition. Retrieved 2nd April,
  147. (2004). Linking physicians' pay to the quality of care-a major experiment in the United Kingdom. New England doi
  148. (2004). Living with advanced heart failure: a prospective, community based study of patients and their carers. doi
  149. (1989). Long term outcomes of an arthritis self-management study: effects of reinforcement effects. doi
  150. (2007). Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure. doi
  151. (2005). Making healthy choices easy choices: the role of empowerment. doi
  152. (2007). Management of chronic heart failure: a national clinical guideline doi
  153. (2000). Management of heart failure: evidence versus practice. Does current prescribing provide optimal treatment for heart failure patients?
  154. (2002). Measuring potentially avoidable hospital readmissions. doi
  155. (2001). Myth of empowerment in chronic illness. doi
  156. (2000). National service framework CHD: chapter 6 heart failure. London: Department of Health.
  157. (2000). National service framework for coronary heart disease. London: Department of Health. doi
  158. (1985). Naturalistic inquiry. doi
  159. (2004). Neighbourhood statistics. doi
  160. (1999). Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. doi
  161. (2008). Numeracy and communication with patients: they are counting on us. doi
  162. (2002). Nurses's knowledge of heart failure education principles. doi
  163. (2001). On 'systematic' reviews of research literatures: a 'narrative' response to Evans & doi
  164. (2003). on behalf of the Dutch Working Group on Heart Failure. doi
  165. (2001). On happiness and human potentials: a review of research on hedonic and eudaimonic well-being. doi
  166. (2006). Our health, our care, our say: a new direction for community services (Cm 6737). London: The Stationery Office.
  167. (2000). Outcome measurement: self-management in heart failure.
  168. (2000). Paradigmatic controversies, contradictions and emerging confluences.
  169. (2005). Parsons revisited: from the sick role to...? doi
  170. (2003). Patient choice in the NHS: the view from economic sociology. doi
  171. (1994). Patient education needs as reported by congestive heart failure patients and their nurses. doi
  172. (2001). Patient education: a practical approach. Thousand Oaks:
  173. (2006). Patient focused interventions: a review of the evidence.
  174. (2009). Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. doi
  175. (2006). Patients strategies for managing medication for chronic heart failure. doi
  176. (2006). Patients using the Internet to obtain health information: How this affects the patient–health professional relationship. Patient Education and Counseling, doi
  177. (1999). Patients, doctors and contracts: an application of principalagent theory to the doctor-patient relationship. doi
  178. (1999). Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. doi
  179. (2007). Patients' persistence of evidence-based treatment of chronic heart failure: A Treatment Paradox. doi
  180. (1998). Patients' preferences for participation in clinical decision making: a review of published surveys. doi
  181. (2000). Patients' unvoiced agendas in general practice consultations: qualitative study. doi
  182. (2005). Patients‟ perceived barriers to active self-management of chronic conditions. Patient Education and Counseling, doi
  183. (2008). Patients‟ trust in physicians: many theories, few measures, and little data. doi
  184. (2005). Perceived barriers for treatment of chronic heart failure in general practice; are they affecting performance? doi
  185. (1999). Perceived learning needs of patients with heart failure. doi
  186. (1999). Perceptions of Latinos, African Americans, and Whites on media as a health information source. doi
  187. (1990). Personality structure: emergence of the Five-Factor Model. Annual Reviews in doi
  188. (2008). Physician autonomy and informed decision making: finding the balance for patient safety and quality. doi
  189. (2005). Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study. doi
  190. (2007). Point prevalence of neurosis in the Lundby Study 1947-1997. doi
  191. (2003). Practical clinical trials increasing the value of clinical research for decision making in clinical and health policy. doi
  192. (2007). Prevalence and determinants of cognitive impairment in chronic heart failure patients. Congestive Heart Failure, doi
  193. (2001). Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. doi
  194. (2008). Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care. doi
  195. (2007). Profile of cognitive impairment in chronic heart failure. doi
  196. (1997). Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy.
  197. (2005). Psychological interventions for depression in heart failure. doi
  198. (2004). Psychometric testing of the self-care of heart failure index. doi
  199. (2005). Qualitative case studies.
  200. (1994). Qualitative data analysis for applied policy research. In doi
  201. (1994). Qualitative data analysis: an expanded sourcebook doi
  202. (2002). Qualitative researching. doi
  203. (2000). Qualitative study of views of health professionals and patients on guided self management plans for asthma. doi
  204. (2009). Quality and Improved Performance Retrieved doi
  205. (2009). Quality and Outcomes Framework. Retrieved 20th August,
  206. (2001). Quality of life in patients with heart failure: do gender differences exist? doi
  207. (2002). Quantitative research: surveys Research methods in health: investigating health and health services (2 ed.). doi
  208. (2005). Quick assessment of literacy in primary care: the newest vital sign.
  209. (2007). Re-thinking the relationship between long-term condition self-management education and the utilisation of health services. doi
  210. (2003). Readiness for Behavioral Changes in Patients With Heart Failure.
  211. (2002). Recent developments: management of chronic heart failure. doi
  212. (1998). Relating member ability and personality to work-team processes and team effectiveness. doi
  213. (2007). Relationship between depressive symptoms and long-term mortality in patients with heart failure. doi
  214. (2001). Reliability and validity of the compliance belief scales among patients with heart failure. doi
  215. (1990). Research methods. doi
  216. (2005). Resisting medicines: a synthesis of qualitative studies of medicine taking. doi
  217. (2006). Roles, power and subjective choice. doi
  218. (2004). Royal College of General Practitioners. doi
  219. (1999). Saving lives: our healthier nation (Cm 4386). London: The Stationery Office.
  220. (2004). Securing good health for the whole population. London: HM Treasury.
  221. (2002). Securing our future health: taking a long-term view. London: HM Treasury.
  222. (1999). Self administration of metolzaone reduces readmissions with decompensated congestive cardiac failure.
  223. (1992). Self care teaching for congestive heart failure patients.
  224. (2007). Self care. doi
  225. (2003). Self management education: history, definition, outcomes and mechanisms. doi
  226. (2002). Self-care and the doctor-patient relationship. Medical Care, 40(4 (Suppl)), doi
  227. (2000). Self-care strategies for symptom management in patients with chronic heart failure. doi
  228. (1997). Self-efficacy: the exercise of control. doi
  229. (2002). Self-management education and regular practitioner review for adults with asthma. doi
  230. (1991). Self-management of diabetes mellitus: a critical review. doi
  231. (2006). Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness. doi
  232. (2002). Selfmanagement approaches for people with chronic conditions: a review. doi
  233. (2004). Sex differences: implications for heart failure care. doi
  234. (1999). Shared decision making in a publicly funded health care system: policies exist to reduce the risk of conflict between individual and society. doi
  235. (2003). Shared decision making: developing the OPTION scale for measuring patient involvement. Quality and Safety in Health Care, doi
  236. (2008). Social research methods. doi
  237. (1990). Sociology for pharmacists. doi
  238. (2005). Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. doi
  239. (1980). Street-level bureaucracy: dilemmas of the individual in public services. doi
  240. (1964). Studies of the routine grounds of everyday activities. doi
  241. (2007). Support for self care for patients with chronic disease. doi
  242. (1993). Support groups as open systems: a model for practice and research. doi
  243. (2005). Supporting people with long term conditions: an NHS and social care model to support local innovation and integration. London: Department of Health.
  244. (2005). Supporting people with long term conditions: liberating the talents of nurses who care for people with long term conditions. London: Department of Health.
  245. (2007). Supporting self-care in general practice. doi
  246. (2001). Survey research methods doi
  247. (1997). Systematic reviews: synthesis of best evidence for clinical decisions. doi
  248. (2009). Testing methodological guidance on the conduct of narrative synthesis in systematic reviews: effectiveness of interventions to promote smoke alarm ownership and function. doi
  249. (1995). The active interview. Thousand Oaks: doi
  250. (1995). The art of case study research. Thousand Oaks:
  251. (2006). The Blair Legacy? Choice and Competition in Public Services.
  252. (2005). The crucial role of patient education in heart failure. doi
  253. (2003). The development and implementation of the Chronic Care Management Programme in Counties Manukau.
  254. (2007). The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. doi
  255. (2008). The evolving concept of health literacy. doi
  256. (2007). The Expert Patients Programme: a paradox of patient empowerment and medical dominance. doi
  257. (2006). The Expert Patients Programme: the evidence base.
  258. (2004). The influence of age, gender, and race on the prevalence of depression in heart failure patients. doi
  259. (2007). The Information Centre. doi
  260. (1996). The management of chronic heart failure. doi
  261. (2006). The myth of agency and patient choice in health care? The case of drug treatments to prevent coronary disease. doi
  262. (2000). The myth of objectivity: is medicine moving towards a social constructivist medical paradigm? Family Practice, doi
  263. (2007). The new general practice contract and reform of primary care in the United Kingdom. Healthcare Policy, doi
  264. (2004). The NHS improvement plan: putting people at the heart of public services (Cm 6268). London: The Stationery Office.
  265. (2000). The NHS plan: a plan for investment, a plan for reform (Cm 4818). London: The Stationery Office.
  266. (2001). The postgraduate research handbook.
  267. (1993). The prevalence of dementia, depression and neurosis in later life: the Liverpool MRC-ALPHA Study. doi
  268. (2003). The problem of decompensated heart failure: nomenclature, classification, and risk stratification. The management of decompensated heart failure resulting in hospitalization. doi
  269. (1984). The sense of coherence as a determinant of health.
  270. (1991). The sociology of chronic illness: a review of research and prospects. doi
  271. (2006). The use of routinely collected computer data for research in primary care: opportunities and challenges. Family Practice, doi
  272. (1994). Thick description: toward an interpretive theory of culture. In
  273. (2003). To heal and harm: an economic view of drug safety. London: Office of Health Economics.
  274. (2001). Towards a global definition of patient centred care. doi
  275. (1996). Towards a philosophy of clinical pharmacy.
  276. (2006). Transcript of public lecture given at London
  277. (2005). Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. doi
  278. (2003). Trust and the development of health care as a social institution. doi
  279. (2004). Understanding Health Literacy and its Barriers. Current Bibliographies
  280. (2003). Uptake of self-management strategies in a heart failure management programme. doi
  281. (2004). Use of a patientaccessible electronic medical record in a practice for congestive heart failure: patient and physician experiences.
  282. (2000). Using focus groups to identify barriers to drug use in patients with congestive heart failure. doi
  283. (2005). Validation of self assessment patient knowledge questionnaire for heart failure patients. doi
  284. (2003). Value for money of changing healthcare services? Economic evaluation of quality improvement. doi
  285. (2001). Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools. Quality and Safety in Health Care, doi
  286. (2002). What do patients know about their heart failure? doi
  287. (2003). What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics. doi
  288. (2008). What do we know about adherence and self-care? doi
  289. (2009). What is self care? Retrieved 8th February,
  290. (2004). When is a patient with heart failure adequately informed? A study of patients' knowledge of and attitudes toward medical information. doi
  291. (2000). Who talks? The social psychology of illness support groups. doi
  292. (1993). Why do patients change their general practitioner? A postal questionnaire study of patients in Avon.
  293. (2001). Why does primary care need more implementation research? Family Practice, doi
  294. (2001). Why general practitioners do not implement evidence: qualitative study. doi
  295. (2001). Why is care in the community perceived as a failure? doi
  296. (2009). Your health, your way: a guide to long term conditions and self care.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.