Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease

Abstract

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.

Indicators of integrated care for patients with chronic cardiovascular disease in ambulatory care

“…3,5,[7][8][9][10][11] Undoubtedly, patients with cardiovascular disease (CVD) have a high risk of hospitalization and an elevated need for medical care. 12 As a result, they often require multiple contacts with different healthcare providers, increasing the likelihood of receiving poor and fragmented care. 4 Given the expected incidence of CVD and demographic changes, a more effective and targeted model of care for patients with chronic CVD needs to be developed.…”

“…4 Given the expected incidence of CVD and demographic changes, a more effective and targeted model of care for patients with chronic CVD needs to be developed. 2,[12][13][14][15] In addition, the Polish healthcare system is characterized by fragmented healthcare administration (which significantly complicates coordination at the systemic level) and relatively low healthcare spending. 16 These features make it necessary to study the requirements, practices and challenges of integrating care for people with CVD in the country.…”

“…Improving the integration of CVD care will effectively impact patient functioning, and reduce maintenance costs and needless hospitalizations. 12 It should be noted that, in recent years, there has been a return to the promotion of holistic care, defined as a caring approach that is more concerned about the patient and takes into account all of their needs, goals and values. [12][13][14][15] In addition, available research emphasizes that integration of care should focus on a comprehensive approach to care and multidisciplinary collaboration.…”

“…12 It should be noted that, in recent years, there has been a return to the promotion of holistic care, defined as a caring approach that is more concerned about the patient and takes into account all of their needs, goals and values. [12][13][14][15] In addition, available research emphasizes that integration of care should focus on a comprehensive approach to care and multidisciplinary collaboration. 3,17 There is also evidence that the social dimension needs to be integrated into health service delivery to meet the population health needs.…”

“…Identifying risk factors for CVD and education about these factors should be a regular part of primary care visits. 12,32,33 However, the issue of health still needs to be addressed in primary health care (PHC) analyses of the CVD delivery system. Health needs are seen as the product of a specific clinical condition, resulting in health behaviors, quality of life and the evaluation of health services.…”