Please select the eligibility criteria that correspond to the clinical trial below.
Title: Promoting Self-management Through Adherence Among Heart Failure Patients
Brief Summary: Non-adherence to self-management behaviors is prevalent and accounts for hospital readmissions in heart failure (HF) patients 65 years of age and older. The mechanism to activate and engage HF patients in managing their own care is uncertain. Yet post-acute care service that is vital to improve HF patients' self-management adherence and HF outcomes is suboptimal in rural hospitals (primarily critical access hospitals). The investigators central hypothesis is that patients with higher activation level will have significantly better self-management adherence. This study will test whether Patient AcTivated Care at Home (PATCH) will improve self-management adherence and health outcome (reduced hospital readmissions), as well as the feasibility to translate the research findings to a home based post-acute care service in rural communities.


Options:
A: Inclusion Criteria:

* People 70 years of age or older
* Multimorbidity: 3 or more coexistent chronic conditions defined by 3 distinct International Classification of Diseases (ICD-10) codes with an estimated duration of 6 months or more or based on a clinical decision
* Polypharmacy i.e. five or more different regular drugs (defined as authorised medications with registration numbers) for more than 30 days.
* In inpatient: Estimated minimal length of stay within the cluster is sufficient to apply the intervention
* If outpatient: prescribing physician has GP function and has a planned appointment to conduct intervention

Exclusion Criteria:

* Inability to provide informed consent or to obtain informed consent from a proxy for patients with cognitive impairment
* Direct admission to palliative care (\< 24h after admission)
* Has passed or will pass a systematic structured drug review during this hospitalisation or within the last two months
B: Inclusion Criteria:

* Cost related medicine non-adherence during last 12 months

Exclusion Criteria:

* Family member living at same address of patient who is already enrolled in this trial
* Patient joined practice during last 6 months
C: Inclusion Criteria:

* have HF as one of their discharge diagnoses;
* have New York Heart Association (NYHA) class II to IV symptoms or have NYHA class I symptoms
* have had at least one other HF-related hospitalization or emergency department visit in the previous year;
* are discharged to home;
* pass a mini-cog screen
* understand English;
* have access to a phone.

Exclusion Criteria:

* Have scheduled procedures and/or surgeries during hospitalization;
* Have depressive symptoms (receive a score of 3 or above on the Patient Health Questionnaire-2 (PHQ-2) have documented medical diagnosis or diagnostic evidence of liver cirrhosis;
* Have renal failure (serum creatinine greater than 2.0mg/dl)
D: Inclusion Criteria:

* Age: 60 years and older
* Chronic heart failure (CHF)
* Stable CHF medication including a diuretic
* Hospitalization for decompensated heart failure within past 12 months OR a value of ≥ 350 pg/mL for BNP or ≥ 1,400 pg/mL for NT-proBNP
* Written informed consent

Exclusion Criteria:

* Use of a weekly dosing aid
* Unwillingness or inability to visit a participating pharmacy once a week
* Planned cardiac surgery
* Life-expectancy \< 6 months
* Unwillingness or inability to comply with the study protocol (including drug abuse or alcohol dependency)
* Participation in other studies (currently or in the last 4 weeks)

Answer: C