ABSTRACT
Background: Cardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood. Aim: This study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings. Methods: Data were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis. Results: Eleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging. Conclusion: This study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence.
ABSTRACT
Background: Cardiac rehabilitation (CR) and medical treatment are integrated parts of the intervention for cardiac patients and are a class 1A recommendation. However, CR dropout is reported to be relatively high and little is known about the reasons for CR dropout in primary health settings. Aim: This study investigates causes for CR dropout through a qualitative audit of medical charts among patients with ischaemic heart disease. Methods: This was a qualitative retrospective audit of patient's medical charts. Patients who dropped out from CR between 1 January and 31 December 2018 in five primary health settings were included. Local patient charts provided information related to causes and formed the basis of the analysis. Data were analyzed using thematic analysis. Results: A total of 690 patients were referred for and commenced CR and 199 (29%) dropped out. Twenty-five (12.6%) patients finished CR but were excluded due to standards of ≥180 days between CR meetings, leaving 118 patients included. Four themes as causes for patient's dropout were identified: (1) CR-programmes, (2) logistical, (3) intrapersonal and (4) clinical factors. Conclusion: This study identified new focus areas to which health professionals may attend in reducing drop-out from CR. Organisation of CR, challenges with combining labor market attachment and CR, focus on patient education and comorbidities. The results underline the importance of health professionals emphasizing the benefits of CR and explains that CR enhances long-term labor market attachment. Furthermore, health professionals should encourage participation in patient education and adapt exercise to the individual patient's potential.
ABSTRACT
The psychosocial effects of web-based information have yet to be tested for patients joining a fast-track total hip arthroplasty programme. This study compared and evaluated the psychosocial impact of standard total hip arthroplasty programme, with and without supplementation with a web-based information platform (E-total hip arthroplasty programme). Totally, 299 patients were enrolled in an un-controlled, before-and-after study, 117 in the S-total hip arthroplasty programme group and 182 in the E-total hip arthroplasty programme group. Psychosocial outcomes before and during admission and then 3 months post-surgery were evaluated, with analyses conducted between and within groups. All outcomes improved significantly from pre-admission to 3 months post-surgery, with no between-group differences. In all, 112 of the 182 E-total hip arthroplasty programme patients accessed the learning platform. A subgroup analysis showed no significant differences between users and non-users, either at baseline or in terms of outcome. This study found no positive psychosocial effect between groups, but a significant effect within groups.