Blended collaborative care in the secondary prevention of coronary heart disease improves risk factor control: Results of a randomised feasibility study

Abstract

Background: Risk factor control is essential in limiting the progression of coronary heart disease, but the necessary active patient involvement is often difficult to realise, especially in patients suffering psychosocial risk factors (e.g. distress). Blended collaborative care has been shown as an effective treatment addition, in which a (non-physician) care manager supports patients in implementing and sustaining lifestyle changes, follows-up on patients, and integrates care across providers, targeting both, somatic and psychosocial risk factors. Aims: The aim of this study was to test the feasibility, acceptance and effect of a six-month blended collaborative care intervention in Germany. Methods: For our randomised controlled pilot study with a crossover design we recruited coronary heart disease patients with ⩾1 insufficiently controlled cardiac risk factors and randomised them to either immediate blended collaborative care intervention (immediate intervention group, n=20) or waiting control (waiting control group, n=20). Results: Participation rate in the intervention phase was 67% ( n=40), and participants reported high satisfaction ( M=1.63, standard deviation=0.69; scale 1 (very high) to 5 (very low)). The number of risk factors decreased significantly from baseline to six months in the immediate intervention group ( t(60)=3.07, p=0.003), but not in the waiting control group t(60)=−0.29, p=0.77). Similarly, at the end of their intervention following the six-month waiting period, the waiting control group also showed a significant reduction of risk factors ( t(60)=3.88, p<0.001). Conclusion: This study shows that blended collaborative care can be a feasible, accepted and effective addition to standard medical care in the secondary prevention of coronary heart disease in the German healthcare system.

A randomized controlled trial of brain and heart health manager-led mHealth secondary stroke prevention

“…These results may be correlated to a long-term management of BMI and blood low-density lipoprotein. A previous retrospective study indicated that stroke recurrence was 14.8% in 5.5 years using continuous follow-up and intervention, when compared to the 23.1% recurrence in the non-sustained group (19). Therefore, the study may presented with new changes if the duration of the intervention is extended.…”

Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial

“…Intervention manual and NCM training materials are adapted from materials published in earlier studies [e.g. 11 ] or developed during our own previous studies [ 14 , 15 , 17 ]. Each recruitment center assigns at least one NCM to the intervention cohort recruited at that site.…”

“…The items are answered on a 5-step frequency scale (range 0–16), where a higher score reflects the respondent’s perception that the demands exceed his/her ability to cope. For the present study we define a relevant screening cut-off score > 5 for defining elevated distress as we did in our pilot study [ 14 ]. All outcomes will be assessed in all participants at baseline, month 12 (primary endpoint) and month 18.…”

“…In a pilot study in Göttingen (n = 40) we tested the feasibility and acceptance of a TC approach in patients with CHD in the German health care system [ 13 , 14 ] For the first time in Germany, we combined the theoretical framework from U.S. trials [ 11 , 15 – 17 ] with our clinical expertise from multiprofessional psychosomatic, family medicine, and cardiac rehabilitation facilities. Our pilot data showed that a brief six-month intervention significantly reduced distress and cardiac risk factor burden and 83% of patients rated their satisfaction with the study intervention as high or very high [ 13 , 14 ].…”

Rural patients’ experience of education, surveillance, and self-care support after heart disease related hospitalisation: a qualitative study

“…Recently, Health Policy: A Policy for Iceland’s Health Care until 2030 discussed schemes in which long-distance healthcare services could be implemented in Iceland [ 28 ]. Prior studies have shown promising results on how to achieve risk goals through motivational interviews and solution-focused approaches [ 41 , 42 ]. Interdisciplinary, nurse-led teamwork has also yielded good results [ 43 ].…”