How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

Schröder, Sara Lena; Fink, Astrid; Schumann, Nadine; Plehn, Alexander; Richter, Michael

doi:10.1136/bmjopen-2015-008060

Cited by 5 publications

(1 citation statement)

References 43 publications

(35 reference statements)

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“…Based on the methodology of grounded theory, we conducted an exploratory qualitative longitudinal study of elderly patients with CHD to examine socioeconomic differences in access, utilisation and quality of treatment. 18 A purposive sampling strategy was used to select patients with a confirmed diagnosis of CHD at a university hospital in Germany. Additionally, the patients had to fulfil the inclusion criteria of being between 60 and 80 years and having one additional principal or secondary diagnosis of stable angina pectoris, acute coronary syndrome or cardiac arrhythmia.…”

Section: Methodsmentioning

confidence: 99%

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

2018

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ObjectivesThis qualitative study aims to analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD).DesignA longitudinal qualitative study using in-depth semistructured interviews to explore patients’ experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives.SettingThe University Hospital in Halle (Saale), Germany.Participants41 elderly patients (aged 59–80 years) who suffered from CHD.ResultsFrom various patient’s experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals.ConclusionsDifferences in the patient’s knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient–physician communication and patient knowledge can change the patient’s understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment.Trial registration numberDRKS00007839.

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Section: Methodsmentioning

confidence: 99%

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

2018

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„Das liegt an jedem selbst“ - Eine qualitative Studie zu Versorgungsungleichheiten aus Patientensicht

et al. 2017

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The aim of this qualitative study was to explore inequalities in healthcare from the patient's perspective. 44 semi-structured interviews with patients, aged 59-80 years, were conducted at the university hospital in Halle, Germany in 2014 and 2015. We analyzed the narratives following inductive qualitative content analysis. Most of the patients (82%) perceived inequalities in healthcare. Dimensions of healthcare inequalities from the patient's perspective were regional differences, type of health insurance, quality of physicians and the patients themselves (Income, Age). The patient's engagement in utilization was mentioned most often as a dimension of inequalities, but not considered a disadvantage. From the patient's perspective, inequalities were more prevalent in the outpatient sector (waiting time, lack of time). Economization in the healthcare system was viewed as the main reason of healthcare inequalities. We found no differences between patients of high and low socioeconomic status. From the patient´s point of view, their own capacity to orient and engage themselves in the healthcare system, as well as reduction of barriers to accessing outpatient care are highly important for reducing inequalities in healthcare.

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Socioeconomic differences in the pathways to diagnosis of coronary heart disease: a qualitative study

Schröder¹,

Fink²,

Hoffmann³

et al. 2017

European Journal of Public Health

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Socioeconomic differences in CHD diagnosis were mainly apparent before patients sought healthcare. These differences were more pronounced when CHD was electively diagnosed due to chronic symptoms rather than urgently diagnosed due to acute symptoms. To address socioeconomic differences, general practitioners should focus on any indication of symptoms and interpretation mentioned by low-SES patients, and coordinate these patients' pathways to diagnosis while emphasizing the seriousness of CHD.

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How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

Cited by 5 publications

References 43 publications

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

„Das liegt an jedem selbst“ - Eine qualitative Studie zu Versorgungsungleichheiten aus Patientensicht

Socioeconomic differences in the pathways to diagnosis of coronary heart disease: a qualitative study

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