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The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial
BACKGROUND: Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) h...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361528/ https://www.ncbi.nlm.nih.gov/pubmed/35941553 http://dx.doi.org/10.1186/s12872-022-02774-8 |
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author | Pedersen, Charlotte Gjørup Nielsen, Claus Vinther Lynggaard, Vibeke Zwisler, Ann Dorthe Maribo, Thomas |
author_facet | Pedersen, Charlotte Gjørup Nielsen, Claus Vinther Lynggaard, Vibeke Zwisler, Ann Dorthe Maribo, Thomas |
author_sort | Pedersen, Charlotte Gjørup |
collection | PubMed |
description | BACKGROUND: Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA). METHOD: A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. RESULT: Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). CONCLUSION: This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02774-8. |
format | Online Article Text |
id | pubmed-9361528 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-93615282022-08-10 The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial Pedersen, Charlotte Gjørup Nielsen, Claus Vinther Lynggaard, Vibeke Zwisler, Ann Dorthe Maribo, Thomas BMC Cardiovasc Disord Research BACKGROUND: Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA). METHOD: A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. RESULT: Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). CONCLUSION: This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02774-8. BioMed Central 2022-08-08 /pmc/articles/PMC9361528/ /pubmed/35941553 http://dx.doi.org/10.1186/s12872-022-02774-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Pedersen, Charlotte Gjørup Nielsen, Claus Vinther Lynggaard, Vibeke Zwisler, Ann Dorthe Maribo, Thomas The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title | The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title_full | The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title_fullStr | The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title_full_unstemmed | The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title_short | The patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
title_sort | patient education strategy “learning and coping” improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361528/ https://www.ncbi.nlm.nih.gov/pubmed/35941553 http://dx.doi.org/10.1186/s12872-022-02774-8 |
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