The effect of patient-centered education in adherence to the treatment regimen in patients with coronary artery disease

Quality of Life in Patients with Coronary Artery Disease-Multicenter POLASPIRE II Study

Background: The quality of life of patients with coronary heart disease is extremely important for their treatment. The aim of the study was to assess the quality of life of patients with coronary artery disease, considering education and compliance with medical recommendations regarding lifestyle changes, as well as the presence of selected cardiovascular risk factors. Methods: The study involved 763 patients from 11 Polish cardiology centers. The presented material is part of the multicenter POLASPIRE II study. Patients completed a standardized questionnaire EuroQol 5D-5Lm. A medical interview was conducted with each patient. All patients had their body weight and height measured and BMI determined. Results: The quality of life of patients was better in men, younger people, those with lower body weight and those who followed preventive recommendations and intensified their physical activity. Most of the examined patients complied with the medical recommendations regarding lifestyle changes after a cardiac incident, but they mainly concerned dietary modifications. There was still a large group of patients who did not comply with the recommendations, e.g., regarding increasing physical activity. Conclusions: The assessment of quality of life depended on many factors, such as gender, body weight and compliance with medical recommendations. The health education of patients in the presented study group was not sufficient. Therefore, there is a need for better education regarding the benefits of following medical recommendations in terms of leading a healthy lifestyle, which consequently improves its quality and duration.

Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review

A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.

PATIENT-CENTERED CARE AND SELF-MANAGEMENT: OPINION OF MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE

OBJECTIVE

The aim: Тo determin attitude of military personnel with coronary artery disease to implementation of the principles of patient- centered care and self-assessment of adherence to treatment.

PATIENTS AND METHODS

Materials and methods: 72 military personnel (male aged 30-58 years) with coronary artery disease, who visited the general practitioners at the Outpatient Care Clinic of the National Military Medical Clinical «Main Military Clinical Hospital» were interviewed anonymously, using the specially designed questionnaire. The patients were divided into two groups: the 1st group with individuals of 49 years old and younger (39 military personnel, mean age 42,8«5,0) and the 2nd group who is 50 years and older (33 military personnel, mean age 53,2«2,4 years).

RESULTS

Results: The results of a sociological survey showed that the majority of military personnel with coronary artery disease believe that doctors do not always provide them with enough information about their health (61,1%) and they do not always provide emotional support to solve their health problems (66,7 %). It has been indicated a mismatch between patients' willingness to participate in shared decision-making regarding a treatment (84,7 % of them) and adher¬ence to treatment - 55,6% of surveyed patients rated adherence to treatment by three points or less on a five-point scale. There is no statistically significant difference between military personnel of the 1st and 2nd groups.

CONCLUSION

Conclusions: The results of the study showed the interest and readiness of surveyed military personnel with coronary artery disease to implementation of the principles of patient-centered medical care.

Articulation of postsurgical patient discharges: coordinating care transitions from hospital to home

BACKGROUND

Cardiac surgery patients are at high risk for readmissions after hospital discharge- few of these readmissions are preventable by mitigating barriers underlying discharge care transitions. An in-depth evaluation of the nuances underpinning the discharge process and the use of tools to support the process, along with insights on patient and clinician experiences, can inform the design of evidence-based strategies to reduce preventable readmissions.

OBJECTIVE

The study objectives are 3-fold: elucidate perceived factors affecting the postsurgical discharge care transitions of cardiac surgery patients going home; highlight differences among clinician and patient perceptions of the postsurgical discharge experiences, and ascertain the impact of these transitions on patient recovery at home.

METHODS

We conducted a prospective multi-stakeholder study using mixed methods, including general observations, patient shadowing, chart reviews, clinician interviews, and follow-up telephone patient and caregiver surveys/interviews. We followed thematic and content analyses.

FINDINGS

Participants included 49 patients, 6 caregivers, and 27 clinicians. We identified interdependencies between the predischarge preparation, discharge education, and postdischarge follow-up care phases that must be coordinated for effective discharge care transitions. We identified several factors that could lead to fragmented discharges, including limited preoperative preparation, ill-defined discharge education, and postoperative plans. To address these, clinicians often performed behind-the-scenes work, including offering informal preoperative preparation, tailoring discharge education, and personalizing postdischarge follow-up plans. As a result, majority of patients reported high satisfaction with care transitions and their positive impact on their home recovery.

DISCUSSION AND CONCLUSIONS

Articulation work by clinicians (ie, behind the scenes work) is critical for ensuring safety, care continuity, and overall patient experience during care transitions. We discuss key evidence-based considerations for re-engineering postsurgical discharge workflows and re-designing discharge interventions.