The impact of person-centred care on patients’ care experiences in relation to educational level after acute coronary syndrome: secondary outcome analysis of a randomised controlled trial

Abstract

Background:

Research supporting the benefits of person-centred care is growing, still knowledge about patients’ experiences of person-centred care is limited.

Aim:

To evaluate the effects of person-centred care on patients’ experiences of care, and also in relation to educational level, after an acute coronary syndrome.

Method:

A total of 199 patients aged less than 75 years, hospitalised for acute coronary syndrome, were randomly assigned to either standard cardiac care (n=105) or person-centred care plus standard cardiac care (n=94). Experience of care was assessed at three healthcare settings (hospital, outpatient and primary care) using the 15-item Picker patient experience questionnaire plus two questions concerning information and documentation.

Results:

No significant difference was found at the three healthcare settings between the two study groups in the Picker patient experience questionnaire total score. Item level analysis showed that the person-centred care group significantly improved at all three healthcare settings on information received and in documentation of care compared with the standard cardiac care group (P<0.05). In outpatient care, the person-centred care group reported significantly better family–physician communication (P=0.004) and information for the family (P=0.007) compared with the standard cardiac care group. In patients without postsecondary education, the corresponding figures were even more in favour of the person-centred care group (P=0.0005 and P=0.0049, respectively), and they also reported higher involvement in care decisions (P=0.023).

Conclusion:

A person-centred care approach after an event of acute coronary syndrome improves patients’ care experiences for information, shared documentation and involvement of family and friends. This effect was especially prominent in patients with a low educational level, who were also more involved in care decisions.

Trial registration:

Swedish registry, Researchweb.org, ID NR 65 791

Keywords

Acute coronary syndrome secondary prevention patient-centered care person-centred care randomised controlled trial care experience

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References

Townsend

Wilson

Bhatnagar

et al . Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016; 37: 3232–3245.

Health at a Glance 2015: OECD Indicators . OECD Publications Centre, 2015.

Kleinman

Brennan

Goldberger

et al . Part 5: Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132: S414–S435.

Piepoli

Corra

Benzer

et al . Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010; 17: 1–17.

Rauch

Davos

Doherty

et al . The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: a systematic review and meta-analysis of randomized and non-randomized studies – The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol 2016; 23: 1914–1939.

Chan

Gordon

Chong

et al . Influence of socioeconomic status on lifestyle behavior modifications among survivors of acute myocardial infarction. Am J Cardiol 2008; 102: 1583–1588.

Ahmad

Ellins

Krelle

et al . Person-centred care: from ideas to action. London: The Health Foundation, 2014.

Ekman

Swedberg

Taft

et al . Person-centered care – ready for prime time. Eur J Cardiovasc Nurs 2011; 10: 248–251.

Ekman

Wolf

Olsson

et al . Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012; 33: 1112–1119.

10.

Brannstrom

Boman

Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. Eur J Heart Fail 2014; 16: 1142–1151.

11.

Fors

Ekman

Taft

et al . Person-centred care after acute coronary syndrome, from hospital to primary care – a randomised controlled trial. Int J Cardiol 2015; 187: 693–699.

12.

Hansson

Ekman

Swedberg

et al . Person-centred care for patients with chronic heart failure – a cost-utility analysis. Eur J Cardiovasc Nurs 2016; 15: 276–284.

13.

Fors

Swedberg

Ulin

et al . Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomised controlled trial. Int J Cardiol 2017; 249: 42–47.

14.

Garratt

Solheim

Danielsen

National and Cross-National Surveys of Patient Experiences: A Structured Review. Oslo, Norway: The Norwegian Institute of Public Health (NIPH), 2008.

15.

Stein

Day

Karia

et al . Patients’ perceptions of care are associated with quality of hospital care: a survey of 4605 hospitals. Am J Med Qual 2015; 30: 382–388.

16.

Glenngard

Anell

Process measures or patient reported experience measures (PREMs) for comparing performance across providers? A study of measures related to access and continuity in Swedish primary care. Primary Healthcare Res Dev 2018; 19: 23–32.

17.

Doyle

Lennox

Bell

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3: e001570.

18.

The National Board of Health and Welfare. National Guidelines for Cardiac Care. 2008/2011. http://www.socialstyrelsen.se/nationellariktlinjerhjartsjukvard/ (accessed 11 september 2018).

19.

Jenkinson

Coulter

Bruster

The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care 2002; 14: 353–358.

20.

Wolf

Olsson

Taft

et al . Impacts of patient characteristics on hospital care experience in 34,000 Swedish patients. BMC Nurs 2012; 11: 8.

21.

Leonardsen

Grondahl

Ghanima

et al . Evaluating patient experiences in decentralised acute care using the Picker Patient Experience Questionnaire; methodological and clinical findings. BMC Health Serv Res 2017; 17: 685.

22.

Di Castelnuovo

Quacquaruccio

Donati

et al . Spousal concordance for major coronary risk factors: a systematic review and meta-analysis. Am J Epidemiol 2009; 169: 1–8.

23.

Christakis

Allison

PD.

Mortality after the hospitalization of a spouse. New Engl J Med. 2006; 354: 719–30.

24.

Andersson

Borglin

Sjostrom-Strand

et al . Standing alone when life takes an unexpected turn: being a midlife next of kin of a relative who has suffered a myocardial infarction. Scand J Caring Sci 2013; 27: 864–871.

25.

Moser

Dracup

Role of spousal anxiety and depression in patients’ psychosocial recovery after a cardiac event. Psychosom Med 2004; 66: 527–532.

26.

Nguyen

Bellucci

Nguyen

LT.

Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Informatics 2014; 83: 779–796.

27.

Esch

Mejilla

Anselmo

et al . Engaging patients through open notes: an evaluation using mixed methods. BMJ Open 2016; 6: e010034.

28.

Delbanco

Walker

Bell

et al . Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157: 461–470.

29.

Oterhals

Hanestad

Eide

et al . The relationship between in-hospital information and patient satisfaction after acute myocardial infarction. Eur J Cardiovasc Nurs 2006; 5: 303–310.

30.

Valaker

Norekval

Raholm

et al . Continuity of care after percutaneous coronary intervention: the patient’s perspective across secondary and primary care settings. Eur J Cardiovasc Nurs 2017; 16: 444–452.

31.

Ekman

Wolf

Vaughan Dickson

et al . Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study. Eur J Cardiovasc Nurs 2017; 16: 646–654.

32.

Ekman

Kjork

Andersson

Self-assessed symptoms in chronic heart failure – important information for clinical management. Eur J Heart Fail 2007; 9: 424–428.

33.

Timmins

A review of the information needs of patients with acute coronary syndromes. Nurs Crit Care 2005; 10: 174–183.

34.

Luhr

Holmefur

Theander

et al . Patient participation during and after a self-management programme in primary healthcare – the experience of patients with chronic obstructive pulmonary disease or chronic heart failure. Patient Educ Counsel 2018; 101: 1137–1142.

35.

Verlinde

De Laender

De Maesschalck

et al . The social gradient in doctor–patient communication. Int J Equity Health 2012; 11: 12.

36.

Fors

Taft

Ulin

et al . Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016; 15: 186–194.

37.

Fors

Gyllensten

Swedberg

et al . Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016; 221: 957–962.

38.

Kandelaki

Marrone

Lundborg

et al . Patient-centredness as a quality domain in Swedish healthcare: results from the first national surveys in different Swedish healthcare settings. BMJ Open 2016; 6: e009056.