Application of Disease Management Program (DMP) Framework for Clinical Decision-Making, Education, Monitoring, and Multidisciplinary Clinical Practices in Heart Failure (HF) Care in Middle-Income Countries (Article Critique) (Article Critique Sample)

Application of Disease Management Program (DMP) Framework for Clinical Decision-Making, Education, Monitoring, and Multidisciplinary Clinical Practices in Heart Failure (HF) Care in Middle-Income Countries (Article Critique) Student's Name Institutional Affiliations Course Title Professor's Name Date Application of Disease Management Program (DMP) Framework for Clinical Decision-Making, Education, Monitoring, and Multidisciplinary Clinical Practices in Heart Failure (HF) Care in Middle-Income Countries (Article Critique) Introduction Recent developments have seen an increase in research literature addressing various issues in Cardiac Nursing clinical practices to improve care practices and outcomes. However, most research is directed to valvular heart disease, prevention and management techniques, and advanced cardiac pharmacology. Bocchi, Moreira, Nakamuta, and Simões (2021) conducted an observational cross-sectional study to evaluate whether the components of the DMP for Heart Failure (HF) patients impact clinical decision-making and how the elements influence care practices in Brazil. In their article, the authors evaluate the status of care models for HF care in Brazilian cardiology centers. Their second objective was to report the characteristics of the models, including how the centers educate patients and caregivers, monitors HF, and rehabilitates patients. In addition, they assess various multidisciplinary team components and collaborative characteristics in clinical environment care models, demographic data, and the structure of participating centers. Finally, the study evaluates the impacts of these factors on effective clinical care for HF patients. Data is collected from private and public clinical settings and compared, and conclusions are drawn from the analysis results. This analysis evaluates the problem. The main themes addressed were the research method and the study findings. The report also critically reviews the interpretation of the study's results and the authors' conclusion concerning best clinical practices in HF care and other research findings. The central themes, management strategy, and the specific problem examined The main themes addressed by this article are disease management using the DMP framework, clinical decision-making, education monitoring, and multidisciplinary treatment model among heart disease patients. Among patients over 65 years, HF is the root cause of hospitalization, readmission, and rising costs of care across the U.S (McClellan, Brown, Califf, & Warner, 2019). It is a critical healthcare burden to care systems despite efforts to improve the situation using the DMP model. The DMP framework aims to optimize drug therapy, facilitate vigilant follow-up for timely flagging of complications, detect and manage comorbidities, provide patient education, reduce HF-related mortality and admissions, and enhance the overall quality of life among HF patients. In advanced healthcare systems and countries, studies show that the DMP model has numerous components that improve care outcomes in a clinical context. However, according to Duarte-Clíments et al. (2021), CVD imparts heavier burdens on patients from low and mid-income countries. Therefore, the current research explores the impacts of DMP components in middle and low-income countries. Specifically, the study uses a survey to evaluate the application of the model in Brazil, a middle-income nation. Methods of investigation used in the study The study uses a survey where cardiologists are the respondents. The method is easy to use and efficient in the collection of information. In addition, the plan is cost-effective and requires less time because data can be collected from multiple sources concurrently and usable remotely (Gaille, 2020). The participants are invited to participate in the survey via email and printed forms. The survey's 29 questions were comprehensive and well-designed to address site demographics in the private and public sectors, HF clinical management, patients' baseline data, perceptions of treatment/care, and performance indicators. The strength of anonymous responses is that they minimize bias and enhance the accuracy of responses from participants. Stratification of HF data concerning clinical practices and disease management is also a study's strength. There are various limitations in the study's data collection and analysis strategy. First, the study only considers cardiologist participants rather than the who spectrum of care providers for HF patients. Second, it fails to consider the overall Family Health Strategy (FHS) used in Brazil and its impact on access to care, such as regular screening, which can be a vital performance indicator in HF care (Özçelik, Massuda, McConnell, & Castro, 2020). Third, the research uses a cross-sectional method that could be biased in sampling approaches and the selection of centers and study variables. Such bias could potentially lead to underestimation or overestimation of actual values (Bocchi, Moreira, Nakamuta, & Simões, 2021). Finally, the survey was self-reported and never involved any data monitoring strategy. Responders gave feedback based on their perception and conceptualization of the clinical application of the model among HF patients. The survey used questionnaires only as a data collection method. Failing to consider patient chart review on clinical queries in HF means that the researchers could have missed critical information relevant to the study. Inadequacy might have impacted the truth about actual clinical occurrences and the outcomes of HF care. The study may have missed essential information, including patient demographics, diagnosis procedures, lab and radiology results, medication, clinical notes and documents, pathology reports, and flow sheet records (Stanford University, 2022). The study fails to address critical issues in HF patients' survival, long-term management, and quality of life. According to Koirala, Himmelfarb, Budhathoki, and Davidson (2020), modern clinical practices in cardiovascular care integrates self-care to improve outcomes. They can also enhance QoL and help manage emotional and physical symptoms to avoid complications (Wiśnicka, Lomper, & Uchmanowicz, 2022). Evaluation of study findings The findings address the problem and meet the objectives of the study. They indicate that public HF-DMPs have a higher percentage of dedicated service, multidisciplinary DMP, educational programs, written instructions for facilitating care before discharge, rehabilitation, monitoring, and higher guideline-directed medical therapy than private clinical practice (Bocchi, Moreira, Nakamuta, & Simões, 2021). However, the public sector is associated with lesser key performance indicators (KPI) and B-type natriuretic peptide (BNP) dosage as biomarkers. According to research, severe valvular heart disease requires evaluation and intervention by a multidisciplinary team in a referral or consultation model of care (Otto et al., 2021). The study agrees with this assertion. It further indicates that multidisciplinary HF-DMP is associated with more educational initiatives than non-MHF DMP, more written instructions, rehabilitation, and monitoring. Non-MHF is associated with less use of BNP biomarkers and KPI. The findings are consistent with other studies concerning clinical practices in the HF context. For example, research indicates that most complicated coronary heart disease (CHD) cases are attributed to poor control of risk factors in routine clinical practice (Sverre et al., 2017). According to another study, impaired cardiovascular functioning among international university students from Brazil is related to various risk factors (Duarte-Clíments et al., 2021). A study shows a relationship between CVD prevalence and specific risk factors. These factors include pharmacological agents, sedentary lifestyles, insufficient knowledge, dyslipidemia, history of heart disease in the family (Bays et al., 2021). Nursing diagnosis and the availability of online information can help modify some of the risk factors for CVD through education. The article argues that physicians consider introducing or adjusting medications after hospitalization or when a patient experiences worsening HF symptoms. In addition, the most significant medical challenges associated with the clinical practice are non-drug treatment factors and adherence to drug treatment. The article fails to offer clarity on age-specific risk factors among HF patients. In their research, Gooding et al. (2020) argue that age-specific strategies must address newer risk factors since generations undergo numerous economic, technological, and social transformations that differentiate them from previously identified risk factors in HF. The changes in context demand are repositioning evidence-based clinical practices and management strategies to accommodate newer contexts in cardiovascular health. Brazil's care systems have both public and private healthcare systems. Research indicates that the population combines service providers due to the unique benefits of the two systems (Silva et al., 2021). The article under review generalizes the results despite selecting a few centers dealing with HF in Brazil. However, this may not reflect the accurate picture of clinical factors in all hospitals attending to HF patients in the country. However, there is no consistency in various features of MDPs in multiple centers, indicating controversial results that differ from prospective trials in monitoring, rehabilitation, and educational programs for HF patients. In addition, care programs are unique in every care center and may lead to differing outcomes. Analysis of the research conclusion and recommendations concerning nursing care The study concluded that DMPs are significantly heterogenous in clinical practices for HF. Therefore, the study can be crucial i...