Variables determining higher health care effectiveness in patients with cardiovascular disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The projected incidence of cardiovascular disease and the aging population (deaths from cardiovascular disease increase after age 50) are expected to increase in the coming years. It is therefore imperative to improve health care for patients with CVD in primary care. Objective The aim of this study was to analyze the variables that influence the efficiency of health care delivery, which is synonymous with high quality of life, intensification of health behaviors, and high satisfaction of needs in patients with chronic cardiovascular disease. Methods The study was conducted on 157 patients with chronic cardiovascular disease who came to a follow-up appointment with a general practitioner. 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 Version (HADS-M) were used for the study. The Wilcoxon test and Fisher's exact test, as well as Spearman's rank correlation coefficient and logistic regression, were used for the analyzes. Results Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.96, 95% CI: 0.92-0.99), educational level (OR = 1.45, 95% CI: 1.13-1.91), financial status (OR = 0.98, 95% CI: 0.20-0.89), assessment of physical well-being (OR = 2.60, 95% CI: 1.29-5.65), improvement in psychological well-being after a nurse visit (OR = 1.36, 95% CI: 0.00-0.17), and medication irregularity (OR = 0.30, 95% CI: 0.09-0.86). There was no association between effectiveness of care and duration of cardiovascular disease (p = 0.149), number of visits to a cardiology clinic (p = 0.414), number of visits to a PHC (p = 0.223), interventions by a family nurse practitioner (p = 0.075), and health care services provided by a physician such as ae.g., medical interview (p = 0.064), physical examination (p = 0.731), blood pressure measurement (p = 0.558). Conclusions Patients with CVD characterized by lower educational status, poorer financial status, poorer self-perception of physical well-being, expectation that the GP will provide information about disease progression, expectation that a social worker will provide information about the possibility of receiving social services, and the expectation that the family nurse would be more accessible when needed, as well as being characterized by irregular medication adherence and nonadherence to good eating habits, were much more likely to receive worse health care. Patients with cardiovascular disease can be well supported in primary care settings as long as the model of care is tailored to their specific needs. This includes care coordination within the health care team, home care, and support from general practice.