Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases

Abstract

The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.

Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review

“…The management by the patient of his or her care treatment plan has become increasingly important [ 24 , 50 , 51 , 53 , 67 ]. This translates into shared decision-making on care and treatment [ 3 , 14 , 24 , 35 , 51 , 53 , 55 – 58 , 64 , 65 ]. According to Devi et al [ 51 ], this process can only be viable if supported by good information about treatment possibilities and possible outcomes.…”

“…A preliminary search for existing reviews was conducted in Cochrane Database, JBI Database of Systematic Reviews and Implementation Reports and PROSPERO. Care pathways have been the subject of few reviews, but these were limited to a single pathology such as cancer in general [ 33 ], blunt thoracic injury [ 34 ], cardiovascular disease [ 35 ], adolescent idiopathic scoliosis [ 36 ] or for particular pathway phases [ 37 ]. In the end, focusing on a single condition is not entirely consistent with a patient-centered approach to care insofar as patients often have comorbidities.…”

World Heart Federation Roadmap for Hypertension – A 2021 Update

“…Contextual relevance and resource availability are two critical elements influencing the sustainability and scalability of hypertension control initiatives in any given setting. It is also important to note that patient pathways are often not linear, which is often not recognised in dominant treatment models [ 79 ]. Disruptions in patient pathways and re-entry into any stage is possible based on changes in barriers and facilitators to care at different levels over time.…”

Benefits and Limitations of Business Process Model Notation in Modeling Patient Healthcare Trajectory: A Scoping Review Protocol

“…It consists rst of the patient's journey through the sequencing of tasks and activities at all points of contact 35,36 . It then integrates both the professional actors involved in the care trajectory 37,38 but also the operation management of care delivery processes 39,40 , the coordination structures [41][42][43] , the structural context of the system and organizations 44,45 and nally the information trajectory along the healthcare trajectory 46,47 . Thus, our understanding of the term healthcare trajectory is not limited to the operational aspect of the care process and to the pathophysiological process of a patient's disease state, but also refers to the total organization of work done throughout all medical workers and patient interactions, as well as the effectiveness of patient care processes on those interactions and the organization.…”