Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:221

Article

Fors, Andreas^1,2,3  Gyllensten, Hanna^1,2,4  Swedberg, Karl^2,5,6  Ekman, Inger^1,2 

[1] Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Box 457, S-40530 Gothenburg, Sweden

[2] Univ Gothenburg, Ctr Person Ctr Care GPCC, Gothenburg, Sweden

[3] Reg Vastra Gotaland, Primary Hlth Care, Narhalsan Res & Dev, Gothenburg, Sweden

[4] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[5] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden

[6] Imperial Coll, Natl Heart & Lung Inst, London, England

关键词: Cardiac rehabilitation;    Myocardial infarction;    Patient-centered care;    Person-centred care;    Randomized controlled trial;    Socioeconomic factors;   

DOI  :  10.1016/j.ijcard.2016.07.060

来源: Elsevier

【 摘 要 】

Aim: The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. Method: 199 Patients <75 years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6 months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. Results: In the group of patients without postsecondary education (n = 90) the composite score showed a significant improvement in favour of the PCC intervention (n = 40) vs. usual care (n = 50) at six months (35.0%, n = 14 vs. 16.0%, n = 8; odds ratio (OR) = 2.8, 95% confidence interval (CI): 1.0-7.7, P = 0.041). In patients with postsecondary education (n = 109), a non-significant difference in favour of the PCC intervention (n = 54) vs. usual care (n = 55) was observed in the composite score (13.0%, n = 7 vs 3.6%, n = 2; OR = 3.9, 95% CI: 0.8-19.9, P = 0.097). Conclusion: A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.

【 授权许可】

Free