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Men and women ages 55 and older Free of any medical condition that would limit participation in independent exercise Not currently engaged in a regular pattern of physical conditioning Free of clinical psychopathology Planning to remain in the geographic area through the duration of the cgat Able to read and speak English sufficiently to understand protocol materials Can use the telephone unaided Willing to accept random asment to any study condition Exclusion Criteria: Under the age of 55 Currently under treatment for an acute, serious Indiana, IN milf dating condition e.

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Accepted for publication 19 July The system of care could also be readily adapted for a range of chronic diseases and health systems. Key words: chronic disease management; chronic heart failure; integrated health care systems; teelphone care, rural health services; telemedicine; telenursing Introduction Chronic heart failure CHF is a major public health problem. It is associated with a worse prognosis than most cancers and requires frequent, prolonged, and costly admissions to hospital.

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A major component of the intervention package is in the form of prerecorded teelphone CHF management scripts based on the Australian national guidelines for both the pharmacological and non-pharmacological management of CHF. Study aims and objectives The primary aim of the CHAT study is to develop an effective preventative and supportive management strategy for Australians with CHF, particularly those residing in rural and remote communities.

Secondary aims include comparing total hospitalized days, the proportion of patients on target doses of angiotensin converting enzyme ACE inhibitors and changes in brain natriuretic peptide BNP levels. The cost-effectiveness of the intervention will also be determined. Initially, the study chta widely publicised to the Australian general practice population through various general practice networks and journals. A member of the research team then contacted interested GPs regarding enrolment.

GP randomization The general practice will be cat unit of randomization. A cluster randomization trial is the de of choice aimed to prevent contamination between patient study groups. Participating practices will first be stratified by RRMA before being randomly allocated to the standard care or intervention group. Patient recruitment Appropriate to a cluster-de randomised controlled trial conducted in general practice, all patients from a single practice are ased to the same study arm.

The GP will act as guardian for their consenting patients in so far as their participating patients will consent without knowing to which study group their GP practice has already been allocated.

Enrolling patients will only be given details of this asment once informed consent has been provided and included only once the selection criteria have been met Table 1. Intervention vs. Once demonstrated, they will be instructed to call telephlne, using a free-call at no less than monthly intervals for a month period Fig.

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The patient has the choice to leave a voice message for the nurse or to request a telephone follow-up call. We hypothesize a positive correlation between the frequency of calls and the effect of the intervention.

Patients are more likely to learn skills associated with increased self-care activity the more feedback and reinforcement they receive teelphone interacting with both the TeleWatchTM system and the CHAT nurses. To assist with the development of the therapeutic relationship, reported as being more difficult where physical contact is precluded, personal and professional profiles including a photograph of the telephone support nurse and the independent evaluator working within the call center environment will be provided to all participants.

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Patient follow-up Participant contact will be at least monthly for a minimum of 12 months. The nurse-coordinated telephone intervention follow-up will be Lonely woman want sex Chibougamau by specific CHF management training decision support software, the TeleWatchTM telemedicine system. The survey will include questions relating to quality of life, economic assessment and utilization of health services.

This latter measure asks the patient to judge whether their overall health status has changed since the commencement of the study and if so, to define the direction and estimate the magnitude of the change. Also included within the Packer composite score is the occurrence of major clinical events such as hospital admissions for or with CHF, all-cause mortality and withdrawal from intervention due to worsening heart failure within the study period.

Key secondary evaluations include total hospitalized days and patient quality of life Table chhat. Physiological evaluation of the intervention will be determined by BNP analysis. Data analysis and statistical methods The primary outcome or Packer composite score is comprised of the following values: improved, no change or worsened. With an average of three patients per practice in a cluster-randomised de, an intrapractice correlation of 0.

The costs of Married women want sex tonight Avalon intervention and the cost offsets from reduced hospital admissions will be assessed from detailed data prospectively collected on drug utilization, investigations, hospital admissions, attendances at emergency departments and general practitioners scheduled and unscheduled. The measure of health outcome will be derived from mortality outcomes and differences in quality of life as measured by the Euroqol, a generic measure of health-related quality of life 19 and will be expressed in quality-adjusted life years QALYs.

The resultant cost-utility ratios cost per QALY can easily be redefined as a cost per disability adjusted life years DALYs because the disability weights used in the Australian Burden of Disease studies were derived for health states with a Euroqol description. The inclusion of BNP as an objective measure will provide an opportunity to undertake a physiological evaluation of the intervention, which has not ly been evaluated in this manner, and to assess the prognostic capability of BNP within a CHF community-based patient population.

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This is also the first study of its type where the participants are instructed to telephone the nurse rather than receive nurse-initiated telephone calls, which potentially could translate to care being provided for those in greatest need. The CHAT study will telephonee test a novel integrated and semiautomated Felephone support platform that enables patients to telephone as often as they choose, and at a time which suits them best.

There is a growing expectation that GPs will play an increasing role in chronic disease management. Many patients have limited access to formal CHF management programs, particularly in rural and remote areas.

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Five-year survival following a first admission for heart failure. Epidemiology, aetiology and prognosis of heart failure. Uncovering a hidden epidemic. Which patients with heart failure respond best to multidisciplinary disease management? An economic analysis of specialist heart failure nurse management in the UK; can telehpone afford not to implement it?

Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Chicago: Telepbone Heart Association, Guidelines for management of patients with chronic heart failure in Australia. Bbw sex near Norfolk

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Med J Aust ; ; Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Canberra: Department of Primary Industries and Telsphone, Adelaide: NHF Australia, A Guideline for Flexible Diuretic Regimens.

Melbourne: Monash University, Frequency, awareness and pharmacological management of chronic heart failure in Australian general practice. Proposal for a new clinical end point to evaluate the efficacy of drugs and devices in the treatment of chronic heart failure. The Kailua1 personals sex burden of disease study: Measuring the loss of health from diseases, injuries and risk factors.

Prevention of readmission in elderly patients with congestive heart failure: of a prospective, randomised telepgone study. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive cardiac failure.

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Comprehensive discharge planning for the hospitalised elderly. A randomised clinical trial. The Cohere Registry. Hype of Hope. Chronic heart failure in Australian general practice. Our future society: a global challenge.

Vhat 1 - Patient selection criteria Table 2 - Outcome measures Figure 1 Projected s of older patients with coronary heart disease, high blood pressure and heart failure in Australia26 With permission from Prof D.