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Continuity of Nursing Care in Patients with Coronary Artery Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053000. [PMID: 35270693 PMCID: PMC8910524 DOI: 10.3390/ijerph19053000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
Abstract
Coronary artery disease is the leading cause of death worldwide and patient continuity of care is essential. Health professionals can help in the transition stage by providing resources to achieve pharmacological treatment adherence, as well as social and emotional support. The objective was to analyse the effects of nursing interventions based on continuity of care in patients with coronary artery disease after hospital discharge. A systematic review of randomised controlled trials and quasi-experimental studies was carried out. Cochrane, CINAHL, Health & medical collection, Medline, and Scopus databases were consulted in January 2022. PRISMA guidelines were followed with no time limits. In total, 16 articles were included with a total of 2950 patients. Nurse-led continuity of care programs improved the monitoring and control of the disease. Positive effects were found in the quality of life of patients, and in mental health, self-efficacy, and self-care capacity dimensions. Clinical parameters such as blood pressure and lipid levels decreased. The continuity of care provided by nurses had a positive influence on the quality of life of patients with coronary artery disease. Nurse-led care focused on the needs and resources, including continuity of care, plays a key role.
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Turan Kavradim S, Özer Z, Boz İ. Effectiveness of telehealth interventions as a part of secondary prevention in coronary artery disease: a systematic review and meta-analysis. Scand J Caring Sci 2019; 34:585-603. [PMID: 31747080 DOI: 10.1111/scs.12785] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronary artery disease is one of the most important health problems among heart diseases in the world, with high morbidity and mortality. Lifestyle changes in particular are recommended in the latest guidelines for implementing secondary prevention. AIM The aim of this study was to evaluate the effectiveness of telehealth interventions as a part of secondary prevention compared to routine care in those with coronary artery disease. METHOD The systematic review with meta-analysis was performed in accordance with Cochrane methods. Science Direct, Springer Link, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, ProQuest and Network Digital Library databases were searched between 2000 and 2018 up to February 2018. The studies chosen conformed to PICOS inclusion and exclusion criteria. The risk of bias was assessed using the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used in reporting the study. RESULTS Twenty-four studies with a total of 6773 study participants met the inclusion criteria. It was found that telephone call interventions were the most commonly used, text message interventions came second with seven studies, telephone calls in combination with messages were used in four studies and telemonitoring was used in two studies. Compared to routine care, telehealth interventions had moderate significant effects in reducing waist circumference, total cholesterol and triglyceride, improving medication adherence and physical activity, and had small significant effects in reducing blood pressure and smoking cessation. No significant publication bias was found in the main outcomes. CONCLUSION Results showed that the telehealth interventions yielded positive outcomes in lifestyle changes for coronary artery disease. Therefore, telehealth interventions can be used for effective secondary prevention by health professionals who care for individuals with coronary artery disease. Additionally, this study will provide guidance for studies on the development of telehealth intervention.
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Affiliation(s)
- Selma Turan Kavradim
- Faculty of Nursing, Department of Internal Medicine Nursing, University of Akdeniz, Antalya, Turkey
| | - Zeynep Özer
- Faculty of Nursing, Department of Internal Medicine Nursing, University of Akdeniz, Antalya, Turkey
| | - İlkay Boz
- Faculty of Nursing, Department of Obstetrics and Gynecology Nursing, University of Akdeniz, Antalya, Turkey
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Crawshaw J, Auyeung V, Ashworth L, Norton S, Weinman J. Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis. Open Heart 2017; 4:e000685. [PMID: 29344366 PMCID: PMC5761293 DOI: 10.1136/openhrt-2017-000685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/09/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023] Open
Abstract
We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I2=57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I2=35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I2=32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness. PROSPERO registration number CRD42016037706.
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Affiliation(s)
- Jacob Crawshaw
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Lucy Ashworth
- School of Health Sciences, City University of London, London, UK
| | - Sam Norton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King's College London, London, UK
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Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Unverzagt S, Peinemann F, Oemler M, Braun K, Klement A. Meta-regression analyses to explain statistical heterogeneity in a systematic review of strategies for guideline implementation in primary health care. PLoS One 2014; 9:e110619. [PMID: 25343450 PMCID: PMC4208765 DOI: 10.1371/journal.pone.0110619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022] Open
Abstract
This study is an in-depth-analysis to explain statistical heterogeneity in a systematic review of implementation strategies to improve guideline adherence of primary care physicians in the treatment of patients with cardiovascular diseases. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Effect modifiers included the staff responsible for implementation, level of prevention and definition pf the primary outcome, unit of randomization, duration of follow-up and risk of bias. Six clinical and methodological factors were investigated as potential effect modifiers of the efficacy of different implementation strategies on guideline adherence in primary care practices on the basis of information from 75 eligible trials. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. Physician adherence was improved by 62% (95% confidence interval (95% CI) 29 to 104%) or 29% (95% CI 5 to 60%) in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of cardiovascular diseases by around 30% (30%; 95% CI -2 to 71% and 31%; 95% CI 9 to 57%, respectively) compared to tertiary prevention. This study aimed to identify effect modifiers of implementation strategies on physician adherence. Especially the cooperation of different health professionals in primary care practices might increase efficacy and guideline implementation seems to be more difficult in tertiary prevention of cardiovascular diseases.
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Affiliation(s)
- Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, University Halle/Wittenberg, Halle (Saale), Germany
| | - Frank Peinemann
- Children's Hospital, University of Cologne, Cologne, Germany
| | - Matthias Oemler
- Section of General Practice, Institute of Medical Epidemiology, Biostatistics and Informatics, University Halle/Wittenberg, Halle (Saale), Germany
| | - Kristin Braun
- Section of General Practice, Institute of Medical Epidemiology, Biostatistics and Informatics, University Halle/Wittenberg, Halle (Saale), Germany
| | - Andreas Klement
- Section of General Practice, Institute of Medical Epidemiology, Biostatistics and Informatics, University Halle/Wittenberg, Halle (Saale), Germany
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Fridlund B, Jönsson AC, Andersson EK, Bala SV, Dahlman GB, Forsberg A, Glasdam S, Hommel A, Kristensson A, Lindberg C, Sivberg B, Sjöström-Strand A, Wihlborg J, Samuelson K. Essentials of Nursing Care in Randomized Controlled Trials of Nurse-Led Interventions in Somatic Care: A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojn.2014.43023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Selvaraj FJ, Mohamed M, Omar K, Nanthan S, Kusiar Z, Subramaniam SY, Ali N, Karanakaran K, Ahmad F, Low WHH. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial. BMC FAMILY PRACTICE 2012; 13:97. [PMID: 23046818 PMCID: PMC3539990 DOI: 10.1186/1471-2296-13-97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 10/05/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). METHODS This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. RESULTS Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). CONCLUSION Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn. TRIAL REGISTRATION National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.
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Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. INT J EVID-BASED HEA 2010; 8:79-89. [PMID: 20923511 DOI: 10.1111/j.1744-1609.2010.00166.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To synthesis the literature relevant to guideline dissemination and implementation strategies for healthcare teams and team-based practice. METHODS Systematic approach utilising Joanna Briggs Institute methods. Two reviewers screened all articles and where there was disagreement, a third reviewer determined inclusion. RESULTS Initial search revealed 12,083 of which 88 met the inclusion criteria. Ten dissemination and implementation strategies identified with distribution of educational materials the most common. Studies were assessed for patient or practitioner outcomes and changes in practice, knowledge and economic outcomes. A descriptive analysis revealed multiple approaches using teams of healthcare providers were reported to have statistically significant results in knowledge, practice and/or outcomes for 72.7% of the studies. CONCLUSION Team-based care using practice guidelines locally adapted can affect positively patient and provider outcomes.
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Affiliation(s)
- Jennifer Medves
- School of Nursing, Queen's University, Kingston, Ontario, Canada.
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Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. INT J EVID-BASED HEA 2010. [DOI: 10.1111/j.1479-6988.2010.00166.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buckley BS, Byrne MC, Smith SM. Service organisation for the secondary prevention of ischaemic heart disease in primary care. Cochrane Database Syst Rev 2010:CD006772. [PMID: 20238349 DOI: 10.1002/14651858.cd006772.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ischaemic heart disease (IHD) is a major cause of mortality and morbidity and its prevalence is set to increase. Secondary prevention aims to prevent subsequent acute events in people with established IHD. While the benefits of individual medical and lifestyle interventions is established, the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community settings is less so. OBJECTIVES To assess the effectiveness of service organisation interventions, identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring (blood pressure, cholesterol and lifestyle factors such as diet, exercise, smoking and obesity) and appropriate prophylactic medication. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2007, Issue 4), MEDLINE (1966 to Feb 2008), EMBASE (1980 to Feb 2008), and CINAHL (1981 to Feb 2008). Bibliographies were checked. No language restrictions were applied. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of service organisation interventions in primary care or community settings in populations with established IHD. DATA COLLECTION AND ANALYSIS Analyses were conducted according to Cochrane recommendations and Odds Ratios (with 95% confidence intervals) reported for dichotomous outcomes, mean differences (with 95% CIs) for continuous outcomes. MAIN RESULTS Eleven studies involving 12,074 people with IHD were included. Increased proportions of patients with total cholesterol levels within recommended levels at 12 months, OR 1.90 (1.04 to 3.48), were associated with interventions that included regular planned appointments, patient education and structured monitoring of medication and risk factors, but significant heterogeneity was apparent. Results relating to blood pressure within target levels bordered on statistical significance. There were no significant effects of interventions on mean blood pressure or cholesterol levels, prescribing, smoking status or body mass index. Few data were available on the effect on diet. There was some suggestion of a "ceiling effect" whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached. AUTHORS' CONCLUSIONS There is weak evidence that regular planned recall of patients for appointments, structured monitoring of risk factors and prescribing, and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure. Further research in this area would benefit from greater standardisation of the outcomes measured.
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Affiliation(s)
- Brian S Buckley
- Department of General Practice, National University of Ireland, Galway, Ireland
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Schadewaldt V, Schultz T. A systematic review on the effectiveness of nurse-led cardiac clinics for adult patients with coronary heart disease. ACTA ACUST UNITED AC 2010; 8:53-89. [DOI: 10.11124/01938924-201008020-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. Practice Guideline Dissemination and Implementation Strategies for Healthcare Teams and Team-Based Practice: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2009; 7:450-491. [PMID: 27819946 DOI: 10.11124/01938924-200907120-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this systematic review is to describe and identify the effectiveness of different practice guideline implementation strategies on team-based practice and/or patient outcomes. METHODS A systematic review was conducted, using a comprehensive, reproducible search strategy that revealed 88 studies that met the inclusion criteria. RESULTS A descriptive analysis revealed multiple approaches using teams of health care providers with 72.7% of the studies reporting statistically significant results in knowledge, practice and/or outcomes. Of 10 dissemination strategies the most effective were reminders, and audit and feedback. The most popular strategy was education meetings. A secondary analysis revealed different populations with chronic or complex disorders where a team approach was effective in practice guideline dissemination and implementation. CONCLUSIONS Many of the studies provided caveats to explain how or why the strategies did or did not demonstrate improvements. Overall, authors described complex health care requiring increasingly complex approaches to ensure evidence based guidelines were utilised in practice, including using multiple dissemination and implementation strategies. The review has provided evidence that a multi-pronged approach to dissemination and implementation of practice guidelines will assist in gaining significant improvements in change in knowledge, practice and patient outcomes.
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Affiliation(s)
- Jennifer Medves
- Queen's Joanna Briggs Collaboration: a Collaborating Centre of the Joanna Briggs Institute, School of Nursing, Queen's University, Kingston, Ontario, Canada
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