LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation

Lynggaard, Vibeke; May, Ole; Beauchamp, Alison; Nielsen, Claus Vinther; Wittrup, Inge

doi:10.1186/1471-2261-14-186

Cited by 17 publications

(69 citation statements)

References 32 publications

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“…Furthermore, the programme created conditions for interacting with—relating to—fellow patients, family members and knowledgeable health‐care staff. Competence and relatedness can facilitate coping and promote patient autonomy . Some participating patients reported actual or anticipated changes in their patterns of health‐care utilization, expecting that they would refrain from going to the emergency room so quickly, due to the Learning Café experience.…”

Section: Discussionmentioning

confidence: 99%

“…A key design idea in such support initiatives is to enable fruitful interactions between fellow persons living with the same condition, family members and health‐care professionals. These interactions, using a non‐hierarchical structure by valuing and giving weight to each team member's views, can provide both experiential and formal disease knowledge that underpin the development of useful coping strategies …”

Section: Introductionmentioning

confidence: 99%

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Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

Suutari

Josefsson

Kjellström

et al. 2019

Health Expectations

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BackgroundAn improvement initiative sought to improve care for atrial fibrillation (AF) patients; many felt insecure about how to cope with AF.ObjectiveTo reveal AF patients' and professionals' experiences of pilot‐testing a Learning Café group education programme, aimed at increasing the patients' sense of security in everyday life.DesignUsing an organizational case study design, we combined quantitative data (patients' sense of security) and qualitative data (project documentation; focus group interviews with five patients and five professionals) analysed using inductive qualitative content analysis.SettingAF patients and a multiprofessional team at a cardiac care unit in a Swedish district hospital.Improvement activitiesTwo registered nurses invited AF patients and partners to four 2.5‐hour Learning Café sessions. In the first session, they solicited participants' questions about life with AF. A physician, a registered nurse and a physiotherapist were invited to address these questions in the remaining sessions.ResultsAF patients reported gaining a greater sense of security in everyday life and anticipating a future shift from emergency care to planned care. Professionals reported enhanced professional development, learning more about person‐centredness and gaining greater control of their own work situation. The organization gained knowledge about patient and family involvement.ConclusionsThe Learning Café pilot test—exemplifying movement towards co‐production through patient‐professional collaboration—generated positive outcomes for patients (sense of security), professionals (work satisfaction; learning) and the organization (better care) in line with contemporary models for quality improvement and with Self‐Determination Theory. This approach merits further testing and evaluation in other contexts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

Suutari

Josefsson

Kjellström

et al. 2019

Health Expectations

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“…Exercise-based cardiac rehabilitation (CR) for patients with ischaemic heart disease (IHD) and heart failure (HF) has been investigated, and is considered cost-effective 1–3. However, many patients with IHD or HF do not succeed in sustaining lifestyle improvements, and only a fraction of the relevant patient group completes CR 4 5. In light of the beneficial effects of CR, it is important to develop patient education strategies which can help patients to improve adherence to CR and make lasting changes towards a healthier lifestyle 4 6 7…”

Section: Introductionmentioning

confidence: 99%

Cost–utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up

Dehbarez¹,

Nielsen²,

Risør³

et al. 2020

Open Heart

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ObjectivesTo enhance adherence to cardiac rehabilitation (CR), a patient education programme called ‘learning and coping’ (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost–utility of the LC-programme compared with the standard CR-programme.Methods825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves.ResultsNo statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI –3828 to 12 533) or in QALY (–0.006; 95% CI –0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%.ConclusionsWhile the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.

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“…In this study, LC strategies were applied and compared with the standard education in CR at three hospitals in the western part of Central Denmark Region (Table 1 ). Detailed components of education strategies is available in the study protocol [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…This method was developed in Norway to address some of the challenges in patient education. Theoretical basis and study protocol of LC strategies has been published before [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial

Dehbarez

Lynggaard²,

May³

et al. 2015

BMC Health Serv Res

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BackgroundLearning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure.MethodsThe study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors.ResultsAn additional cost of DKK 6,043 (95 % CI −5,697; 17,783) and a QALY gain of 0.005 (95 % CI −0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29 % for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62 % over the threshold values.DiscussionThe LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn.ConclusionFuture research should assess the LC strategies' long-term efficacy and cost-utility.Trial registrationNCT01668394

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LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation

Cited by 17 publications

References 32 publications

Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

Cost–utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up

Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial

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