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Bårdsgjerde EK, Kvangarsnes M, Landstad B, Nylenna M, Hole T. Patients' narratives of their patient participation in the myocardial infarction pathway. J Adv Nurs 2018; 75:1063-1073. [PMID: 30549312 DOI: 10.1111/jan.13931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore how patients in areas without local percutaneous coronary intervention (PCI) facilities experience patient participation in different phases of the myocardial infarction pathway. BACKGROUND Acute treatment of myocardial infarction often involves PCI. In Norway, this treatment is centralized at certain hospitals; thus, patients often require long-distance transportation and experience frequent hospital transfers. Short hospital stays, transfers between hospitals and the patient's emotional state pose challenges to promoting patient participation. DESIGN A qualitative design with a narrative approach. METHODS Participants were recruited through purposive sampling. Eight men and two women were interviewed in 2016. FINDINGS Four themes related to the patients' experiences at the beginning, middle and end of the pathway were identified: (a) Lack of verbal communication in the acute phase; (b) trust in healthcare professionals and treatment; (c) lack of participation and coordination at discharge; and (d) shared decision-making in rehabilitation. The findings showed how the patients moved from a low level of patient participation in the acute phase to a high level of patient participation in the rehabilitation phase. CONCLUSION This is the first study to explore patient participation in different phases of the myocardial infarction pathway. We argue that individual plans for information and patient participation are important to improve patient involvement in an earlier stage of the pathway. Further research from a healthcare professional perspective can be valuable to understand this topic. IMPACT This study gives new insight that can be valuable for healthcare professionals in implementing patient participation throughout the pathway.
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Affiliation(s)
- Elise Kvalsund Bårdsgjerde
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Bodil Landstad
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Magne Nylenna
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Gunnell AS, Hung J, Knuiman MW, Nedkoff L, Gillies M, Geelhoed E, Hobbs MST, Katzenellenbogen JM, Rankin JM, Ortiz M, Briffa TG, Sanfilippo FM. Secondary preventive medication use in a prevalent population-based cohort of acute coronary syndrome survivors. Cardiovasc Ther 2017; 34:423-430. [PMID: 27489053 DOI: 10.1111/1755-5922.12212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. METHOD A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989-2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65-89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. RESULTS Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95% CI 0.76-0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08; 95% CI 1.07-1.08) of being dispensed fewer of the recommended drug regimen in 2008. CONCLUSION Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.
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Affiliation(s)
- Anthony S Gunnell
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Joseph Hung
- School of Population Health, The University of Western Australia, Perth, WA, Australia.,School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Matthew W Knuiman
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Lee Nedkoff
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Malcolm Gillies
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia
| | - Elizabeth Geelhoed
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Michael S T Hobbs
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | | | - Jamie M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Michael Ortiz
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tom G Briffa
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Perth, WA, Australia
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