Barriers to effective self-management in cardiac patients: The patient's experience

Mead, Holly; Andres, Ellie; Ramos, Christal; Siegel, B. Z.; Regenstein, Marsha

doi:10.1016/j.pec.2009.08.003

Cited by 48 publications

(57 citation statements)

References 29 publications

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“…Achieving effective HF self-care was widely seen to be very challenging to patients mostly due to difficulties remembering: what self-care behaviours were important28–30 or appropriate to do,28 31 and the harmful effects32 and uncontrollability of symptoms 31 33 34…”

Section: Resultsmentioning

confidence: 99%

Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions

Clark

Spaling

Harkness

et al. 2014

Heart

138

160

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Section: Resultsmentioning

confidence: 99%

Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions

Clark

Spaling

Harkness

et al. 2014

Heart

138

160

View full text Add to dashboard Cite

“…There has been a substantial increase in the body of literature to suggest the effects of self-management interventions on rehabilitation and recovery across a variety of chronic conditions such as stroke (Jones et al, 2009), lymphoedema (McGowan et al, 2013), chronic obstructive pulmonary disease (Fairbrother et al, 2013;Bourbeau et al, 2013) and vascular risk reduction (Sol et al, 2005;Sol et al, 2008;Mead et al, 2010;Maitland and Chalmers, 2010).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

Guo

Harris

2016

International Journal of Nursing Studies

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Please cite this article as: GUO, P., HARRIS, R.,The effectiveness and experience of self-management following acute coronary syndrome: a review of the literature, International Journal of Nursing Studies (2016), http://dx.doi.org/10. 1016/j.ijnurstu.2016.05.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of interestNone. Funding statementNo external funding.Page 3  Evidence has suggested the effects of self-management interventions on rehabilitation and recovery across a variety of chronic conditions. However, to date less is known about the extent of the literature on self-management for individuals following an acute cardiac event. Despite widespread use of the term 'self-management' and growing interest in the concept, defining how self-management is manifested in terms of observable behaviours remains challenging in the field of health and social care. What this paper adds? Evidence showed varying effects of the self-management interventions among people following acute coronary syndrome when compared with usual care.Most studies in this review were conducted in western countries and quantitative studies were UK centric. Therefore, more research is needed to explore self-management among people following acute coronary syndrome within different health care contexts.

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“…Forty-two papers were identified as eligible for inclusion in this review: Aroni et al, 189 Becker et al, 190 Cvetkovski et al, 191 Donald et al, 155 Douglass et al, [192][193][194] Goeman et al, 136,195 Griffiths et al, 196 Hyland et al, 197 Jones et al, 198 Tumiel-Berhalter and Zayas, 199 De Vito, 200 Elkington et al, 110 Hopley et al, 201 Shipman et al, 202 Wilson et al, 203 Balcou-Debussche and Debussche, 204 Brez et al, 205 Broom,206 de-Graft, 207 Heisler et al, 208 Johnson et al, 209 Lawton et al, 210 McDowell et al, 211 Perera et al, 212 Mead et al, 213 Paquet et al, 214 Schoenberg and Peters, 215 Cowie et al, 216 Forsyth et al, 217 Fried et al, 218 Gately et al,…”

Section: Resultsmentioning

confidence: 99%

“…[216][217][218][219]221,222,[224][225][226][227][228] The majority of studies were from the USA (n = 11 190,199,200,208,213,215,217,218,222,224,225 ), Australia (n = 12 136,155,189,[191][192][193][194][195]206,220,221,227 ) or the UK (n = 12 110,196,197,202,[209][210][211]216,219,223,226,228 ). The most frequently studied types of unscheduled care were attendance at the ED and/or EHA.…”

mentioning

confidence: 99%

“…The studies included 2054 participants, comprising 1836 patients, 63 carers and 155 practitioners. The largest study sample size was 387 213 and the smallest was a focus group of five people. 229 Twenty-five of the studies used interviews with users of services, eight used focus groups, five used focus groups and interviews, and four used observation plus interviews.…”

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confidence: 99%

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CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Barriers to effective self-management in cardiac patients: The patient's experience

Cited by 48 publications

References 29 publications

Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions

Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

CHOICE: Choosing Health Options In Chronic Care Emergencies

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