Patient empowerment in secondary prevention of coronary heart disease

doi:10.1016/S0140-6736(00)02513-7

The Lancet

Volume 356, Issue 9226, 22 July 2000, Page 314

https://doi.org/10.1016/S0140-6736(00)02513-7 Get rights and content

Summary

Despite a large evidence base, the practice of secondary prevention in coronary artery disease is suboptimum and needs improvement. We have shown that although patient empowerment led to an increase in cholesterol checks, the action taken by health-care professionals as a result of these checks was poor.

References (3)

D Wood et al.
Joint British recommendations on prevention of coronary heart disease in clinical practice
Heart
(1998)

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Cited by (19)

The you CAN campaign: Teamwork training for patients and families in ambulatory oncology
2009, Joint Commission Journal on Quality and Patient Safety
Citation Excerpt :
Equipping patients with specific teamwork skills may empower them to play a more active role in their care and to engage more collaboratively with their health care professionals. In fact, early studies of asthma, diabetes, and coronary artery disease management have demonstrated that patient empowerment can make a significant impact on clinical outcomes in these areas.22–27 By extension, teamwork training may have a subtle, but critical impact on patient safety.
Health care organizations have begun to adapt high-performance teamwork training techniques from aviation to clinical environments. Oncology care is often delivered in multispecialty teams and with the patient’s and family’s active involvement. To examine the potential value of a patient-oriented teamwork intervention, a teamwork training initiative for oncology patients and their families was developed at the Dana-Farber Cancer Institute.
The content and format of the initiative evolved iteratively on the basis of several core team-training concepts derived from the research literature in health care and aviation. Initially a targeted intervention, the program evolved into a multifaceted campaign that included internal marketing, staff training, and one-on-one patient outreach by a group of volunteers. The You CAN campaign sought to convey a positive and empowering message that encouraged patients to (1) check for hazards in the environment, (2) ask questions of clinicians, and (3) notify staff of safety concerns.
The You CAN campaign was conducted from July through September 2007. To assess its progress, patients were surveyed at baseline and during the campaign. On the basis of the survey results, 32% (95% confidence interval [CI]: 25%–38%) of the ambulatory clinic population, or 1,145 patients, were exposed to the campaign. Although patients rated the quality of teamwork and communication favorably at both baseline and follow-up, there was no significant change in the self-reported use of teamwork techniques on a written survey. However, 39% (95% CI: 27%–51%) of those who were exposed to the campaign said that it changed their behavior.
A training program for patients and their families is feasible in ambulatory oncology and may be applicable to other clinical settings.
Lipid testing among patients beginning statin therapy in general practice in the United Kingdom
2008, Value in Health
To determine the frequency of lipid testing and to identify the factors predictive of lipid-testing frequency over a 1-year period in patients beginning statin treatment.
Retrospective cohort study performed using the UK General Practice Research Database. The patients were selected if they were ≥35 years of age, received first-ever statin between January 2000 and December 2004, had at least one total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), or triglyceride (TG) test conducted in the 1-year period before statin initiation, and had at least 1 year of follow-up data. The main outcome measures were TC, HDL-C, and TG testing frequencies in the year after initiating statins. Poisson regression was used to assess baseline factors associated with testing frequency for each lipid.
In the year after initiating statins, the patients received a mean (±SD) of 1.3 (±1.0) TC tests, 0.9 (±1.0) HDL-C tests, and 0.9 (±1.0) TG tests; however, 22.7%, 44.3%, and 39.1% of the patients did not receive any TC, HDL-C, and TG tests, respectively. In multivariate analyses, a high coronary heart disease (CHD) risk (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07) and elevated baseline TC (≥6.2 vs. <5.0 mmol/L; OR 1.12; 95% CI 1.06–1.18) were significantly associated with greater TC testing frequency.
High risk of CHD and elevated baseline TC were associated with greater rates of TC testing in the year after statin initiation. Lack of TC testing in approximately one in five patients, and infrequent HDL-C and TG testing may be barriers to comprehensive lipid management.
Coaching patients with coronary heart disease to achieve the target cholesterol: A method to bridge the gap between evidence-based medicine and the "real world" - Randomized controlled trial
2002, Journal of Clinical Epidemiology
Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease (CHD). An effective strategy is required for the application of evidence-based prevention therapy for CHD. The objective of this study was to test coaching as a technique to assist patients in achieving the target cholesterol level of <4.5 mmol/L. Patients with established CHD (n = 245) underwent a stratified randomization by cardiac procedure (coronary artery bypass graft surgery or percutaneous coronary intervention) to receive either the coaching intervention (n = 121) or usual medical care (n = 124). The primary outcome measure was fasting serum total cholesterol (TC), serum triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and calculated low-density lipoprotein cholesterol (LDL-C) level, measured at 6 months postrandomization. At 6 months, the serum TC and LDL-C levels were significantly lower in the coaching intervention group (n = 107) than the usual care group (n = 112): mean TC (95%CI) 5.00 (4.82–5.17) mmol/L versus 5.54 (5.36–5.72) mmol/L (P < .0001); mean LDL-C (95%CI) 3.11 (2.94–3.29) mmol/L versus 3.57 (3.39–3.75) mmol/L (P < .0004), respectively. Coaching had no impact on TG or on HDL-C levels. Multivariate analysis showed that being coached (P < .001) had an effect of equal magnitude to being prescribed lipid-lowering drug therapy (P < .001). The effectiveness of the coaching intervention is best explained by both adherence to drug therapy and to dietary advice given. Coaching may be an appropriate method to reduce the treatment gap in applying evidence-based medicine to the “real world.”
Patient empowerment and coronary heart disease [13]
2000, Lancet
Empowerment of individuals to reduce cardiovascular disease [7]
2000, Lancet
Early approach to LDL-related risk after acute coronary syndrome: the OPTA project
2023, Expert Review of Cardiovascular Therapy

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Research LettersPatient empowerment in secondary prevention of coronary heart disease

Summary

Joint British recommendations on prevention of coronary heart disease in clinical practice

Heart

Research Letters
Patient empowerment in secondary prevention of coronary heart disease