Re‐engineering cardiac rehabilitation programmes: considering the patient's point of view

Pâquet, Mariane; Bolduc, Nicole; Xhignesse, Marianne; Vanasse, Alain

doi:10.1111/j.1365-2648.2005.03544.x

Cited by 46 publications

(50 citation statements)

References 44 publications

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“…60 Predictability and stability are hallmarks of well-organized health care and successful transitions, providing a sense of security, coping, and confi dence about future care. 14,29,40,42 Even so, predictability needs to be balanced with fl exibility and adaptation to changing needs, knowing that appointments can be more frequent or that a contingency plan is in place if the patient needs it. 14,29,54 Patients as Active Agents The patient's role emerged in management, informational, and relational continuity.…”

Section: Connectedness Beyond Health Care Encountersmentioning

confidence: 99%

Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Haggerty

Roberge

Freeman

et al. 2013

The Annals of Family Medicine

206

261

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PURPOSE Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients' experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity.METHODS From an initial list of 514 potential studies (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), 33 met our criteria of using qualitative methods and exploring patients' experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes.RESULTS For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians.CONCLUSION Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confi dence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity. Ann Fam Med 2013;11:262-271. doi:10.1370/afm.1499. INTRODUCTIONC ontinuity of care is the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances.1 As patients increasingly receive care from multiple professionals and organizations, improving continuity of care has become a research priority. Although continuity of care is understood differently across health disciplines, an interdisciplinary review of concepts and measures of continuity of care found all disciplines would recognize 3 types of continuity. 1,2 Relational continuity is the therapeutic relationship between a patient and 1 or more clinicians that bridges episodes of care and provides coherence through clinicians' growing comprehensive knowledge of the patient. It is most valued in primary care and family medicine. Informational continuity ensures connectedness and coherence by the uptake of information on past events and is most emphasized in the nursing sciences.3-6 Management continuity refers to consistent and coherent management by different clinicians 263 CONT INUIT Y O F C A R E WIT H MULT IPL E CLINICIANSthrough coordinated and timely delivery of complemen...

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Section: Connectedness Beyond Health Care Encountersmentioning

confidence: 99%

Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Haggerty

Roberge

Freeman

et al. 2013

The Annals of Family Medicine

206

261

View full text Add to dashboard Cite

show abstract

“…» À ce sujet, il est reconnu que le soutien familial a un impact positif sur la récupération, lorsque celui-ci est adéquat. Un certain nombre d'études ont été menées au cours des dernières années, quelques-unes seulement portaient sur des adolescents TCC et leurs familles (Braga, Da Paz Jr et Ylvisaker, 2005;Bragg, Klockars et Berninger, 1992;LeonCarrion, Perino et Zitnay, 2006;Malec, 1993), mais plusieurs ont été réalisées auprès de la clientèle adulte souffrant de différents problèmes de santé (Fraser, 2006;Paquet, Bolduc, Xhignesse et Vanasse, 2005;Wong, Lai, Martinson et Wong, 2006). Celles-ci affirment toutes l'importance du soutien familial sur la récupération.…”

Section: Constats Et Discussionunclassified

Les perceptions d’adolescents cérébrolésés, de leurs parents et des professionnels impliqués dans leur inclusion sociale

Gauvin-Lepage

Lefebvre

2010

efg

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Cette étude qualitative a pour but d'explorer les perceptions d’adolescents, de leurs parents et de professionnelles quant à l'inclusion sociale d’adolescents ayant vécu un traumatisme craniocérébral (TCC) modéré. Le modèle écologique de Bronfenbrenner (1979, 1986), adapté par Lefebvre et Levert (2005) auprès de la clientèle TCC, est utilisé comme cadre de référence. Des entrevues semi-dirigées ont été réalisées auprès d’adolescents cérébrolésés et leurs parents. Les résultats montrent que les perceptions des familles portent sur différents aspects de leur vie, indiquant une multitude de répercussions qui facilitent ou contraignent l’inclusion sociale de l’adolescent TCC modéré. En général, les professionnelles partagent les mêmes perceptions qu’eux. Les résultats de cette étude devraient permettre aux professionnels de la santé une meilleure compréhension de l'inclusion sociale vécue par ces personnes, en plus d'offrir des balises permettant à ceux-ci de mieux soutenir l'inclusion sociale d’adolescents TCC et de venir en aide aux familles dans cette situation difficile.The intention of this qualitative study is to explore the way in which adolescents, their parents and professionals perceive the social inclusion of adolescents who have suffered a moderate craniocerebral trauma (CCT). Our terms of reference will be Bronfenbrenner’s ecological model (1979, 1986), as adapted by Lefebvre and Levert (2005) for use with a CCT case mix. Semi-structured interviews were carried out with brain-damaged adolescents and their parents. The results show that families’ perceptions touch on different aspects of their lives, pointing to a wide range of repercussions that may facilitate or restrict the social inclusion of an adolescent suffering from a moderate CCT. In general, professionals share these same perceptions. The results of the present study should offer health professionals a better understanding of social inclusion as experienced by these adolescents, while at the same time providing the former with guidelines allowing them to better support the social inclusion of CCT adolescents and to help families living through this difficult situation

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“…[55][56][57] However, a number of barriers to patients attending cardiac rehabilitation have been found, of which transport difficulties are a commonly cited barrier. 54,[57][58][59][60][61][62] Several studies have reported that patients may feel embarrassed about exercising in public, 50,57,59 although this may lessen through attendance at cardiac rehabilitation. 50 Some patients dislike group-based formats and prefer home-based cardiac rehabilitation.…”

Section: Patient Perspectives On Cardiac Rehabilitation Programsmentioning

confidence: 99%

“…53 Patients' understanding of the cause of their heart attack was also cited as a potential barrier to attendance at cardiac rehabilitation. 57,59 Additional issues affecting attendance at cardiac rehabilitation include limited resources restricting cardiac rehabilitation service capacity 57,62 or quality. 55, 61 Tod et al found waiting lists of up to 12 months in some cases, and that patients were often unable to access information about the availability of cardiac rehabilitation, especially those patients who did not speak English or who used sign language.…”

Section: Patient Perspectives On Cardiac Rehabilitation Programsmentioning

confidence: 99%

Effectiveness of public health and education programs for creating awareness of and managing cardiovascular disease

White¹

2011

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This paper reviews the effectiveness of public health and education programs for creating awareness of, preventing and managing cardiovascular disease (CVD), with a particular focus on their impact on people's behavior. Evidence-based guidance recommends that such programs, eg, cardiac rehabilitation, should include risk assessment, modification of lifestyle risk factors and, where appropriate, medication. However, despite substantial evidence of cardiac rehabilitation being beneficial, a significant proportion of eligible patients fail to receive cardiac rehabilitation and numerous barriers to attendance remain, particularly because cardiac rehabilitation service provision continues to be patchy and of variable quality. Evidence suggests that educational programs to prevent CVD may achieve favorable reductions in mortality and overall CVD risk. However, whilst people tend to have significant knowledge of the modifiable risk factors for CVD, this does not necessarily lead to action to reduce risk, because lay epidemiology appears to play a significant role in sophisticated determinations of CVD causation, amongst other factors. Some people, but not all, make and maintain some lifestyle changes, but not necessarily all of the changes recommended, because they may only change aspects of lifestyle that are perceived to have been likely causes of their CVD. In addition, many people experience difficulty in making and maintaining lifestyle changes. There appears to be considerable disquiet among patients about taking medicines prescribed for CVD, particularly concerning side effects, which in some instances may affect medicine-taking. New developments and patient approaches recognize the wider societal issues that influence the lifestyle choices people make. Initiatives to increase attendance and widen access to cardiac rehabilitation have included home-based and technological innovations as alternatives to hospital-based cardiac rehabilitation programs. Effective future approaches are likely to build on these developments, and offer even greater choice in accessing preventative services.

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Re‐engineering cardiac rehabilitation programmes: considering the patient's point of view

Abstract: Cardiac rehabilitation programmes need to shift their focus of attention from promoting healthier behaviours to responding to participants' perceived needs, alongside risk factor reduction.

Cited by 46 publications

References 44 publications

Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

Les perceptions d’adolescents cérébrolésés, de leurs parents et des professionnels impliqués dans leur inclusion sociale

Effectiveness of public health and education programs for creating awareness of and managing cardiovascular disease

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