Patient Education Programs Research Articles

Healthcare professionals’ perceptions of using a digital patient educational programme as part of cardiac rehabilitation in patients with coronary artery disease – a qualitative study

BackgroundParticipation in cardiac rehabilitation in patients with coronary artery disease (CAD) remains underutilised. Digital educational programmes, as part of cardiac rehabilitation, are emerging as a means of increasing accessibility, but healthcare professionals’ perceptions of implementing and using these programmes are not known. The aim of the study was therefore to explore healthcare professionals ̓ perceptions and experiences of implementing and using a digital patient educational programme (DPE) as part of cardiac rehabilitation after acute CAD.MethodsIndividual semi-structured interviews were performed with 12 nurses and physiotherapists, ten women with a median age of 49.5 (min 37- max 59) years, with experience of using the DPE as part of a phase II cardiac rehabilitation programme in Region Västra Götaland, Sweden. The interviews were transcribed verbatim and analysed with inductive content analysis according to Graneheim and Lundman.ResultsAn overall theme was identified throughout the unit of analysis: “Digital patient education – a complement yet not a replacement”. Within this theme, three main categories were identified: “Finding ways that make implementation work”, “Accessibility to information for confident and involved patients” and “Reaching one another in a digital world”. Each main category contains a number of sub-categories.ConclusionsThis study adds new knowledge on healthcare professionals’ perceptions of a digital patient educational programme as a valuable and accessible alternative to centre-based education programmes as part of cardiac rehabilitation for patients with CAD. The participants highlighted the factors necessary for a successful implementation, such as support through the process and sufficient time from the employer to learn the system and to create new routines in daily practice. Future research is needed to further understand the impact of digital education systems in the secondary prevention of CAD. Ultimately, hybrid models, where the choice of delivery depends on the preferences of the individual patient, would be the optimal model of care for the future.

User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study.

Artificial intelligence-driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants' user experiences will form the basis for program design improvements. Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users' evaluation is satisfactory. ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517.

Reporting of blood pressure levels and self-monitoring practices: a survey among outpatients diagnosed with hypertension in Bogotá, Colombia

BackgroundRoutine blood pressure (BP) self-monitoring is recommended for patients already diagnosed with hypertension. How often these patients can report their BP levels is unknown, particularly in low-and-middle income countries.MethodsWe surveyed (January 2021 to May 2022) representative samples of patients with established diagnosis of hypertension from 3 health care networks (involving 74 outpatient clinics) and 2 university hospitals in Bogotá, Colombia. Trained health care professionals conducted a telephone survey including questions on demographics, medical history, and general understanding about hypertension and its potential complications. The outcome variables were the self-report of participant’s BP levels (primary) and monitoring practices among participants.ResultsOut of 2609 consecutively contacted patients sampled from institutional records, 2323 were invited and 1566 (mean age 66.5, SD = 12.1 years, 74.4% females, 64.0% living low socio-economic strata) gave consent to participate. While 66% of participants had over 5 years of diagnosis, 39.5% had most (≥ 60%) of their follow-up visits with the same doctor. Overall, 645 (41.5%, 95%CI 39.1 -43.9) participants reported their BP levels. This proportion was independent of time from diagnosis, but higher among those of younger age, living in higher socio-economic strata, having more years of education and using more information technologies. Also, more patients reported their BP levels if seen ≥ 60% of the times by the same physician (43.4% Vs. 36.7%). Those reporting closer BP self-monitoring more often used electronic devices, received 2 + medications, and had better knowledge about hypertension.ConclusionA minority of hypertensive patients seen in Bogotá were aware of their own BP levels. Those in such capacity were in a better social position, more often seen by the same doctor, knew their condition better and handled more complex treatments. Hypertensive patients from Bogotá may benefit from a more continuous medical care, patient education programs and promoting BP home monitoring.

Effects of therapeutic patient education program on glycemic control and quality of life among children and adolescents with type 1 diabetes mellitus in Fez city, Morocco.

Type 1 diabetes mellitus (T1DM) is a chronic disease, mainly observed in children or youth, with a significantly increased incidence in young children. Structured therapeutic patient education (TPE) is a must to help them manage their disease effectively and lead a healthy lifestyle. This study aimed to assess the effects of a structured TPE program on glycemic markers and quality of life (QOL) of T1DM children and adolescents in Fez city, Morocco. It is a quasi-experimental study. One hundred T1DM children and adolescents, aged 8-18, participated in a TPE intervention at the pediatric department in a hospital center in Fez, Morocco. Glycemic markers were measured and QOL was assessed by a validated questionnaire. Parametric and nonparametric tests were used and statistical significance determined by P < 0.05. At 3 months' follow-up, both global and dimensional QOL mean scores improved significantly (P ≤ 0.0001), whereas glycosylated hemoglobin (HbA1c) decreased (10.28% vs. 10.62%), tough with no statistical significance (P = 0.160). Furthermore, a significant improvement was observed in the maximum preprandial (2, 11 g/L [1.51-2.58] vs. 2, 37 g/L [1.81-3.21], P = 0.001) and postprandial blood glucose levels (2, 50 g/L [1.90-3.27] vs. 2, 95 g/L [2.07-3.99], P = 0.001) after 3 months; with no significant change in their minimum. Although this TPE intervention was more effective in improving patients' QOL than their HbA1c, it is worth striving to implement regular TPE programs for T1DM pediatric patients and adjust them to achieve a better patients' glycemic markers levels.

Evaluation of a results-based financing nutrition intervention for tuberculosis patients in Madhya Pradesh, India, implemented during the COVID-19 pandemic

BackgroundReducing malnutrition through food supplementation is a critical component of the WHO End Tuberculosis (TB) strategy. A results-based financing (RBF) initiative in Madhya Pradesh, India—called Mukti—introduced an intensive nutrition intervention, including home visits, counseling, food basket distribution, and assistance in obtaining government benefits. Phase 1 of the program (Dhar District), implemented by ChildFund India (ChildFund) and funded by USAID, coincided with the COVID-19 lockdown in 2020. Under an RBF reimbursement scheme, ChildFund was paid based on treatment retention for 6 months and weight gain of 6 kg for adults.MethodsThe evaluation used a mixed methods approach. Qualitative components included interviews with key informants and focus groups with program participants. Quantitative components included an analysis of program data (i.e., patient demographics, receipt of program services, and weight gain). An impact analysis of retention in treatment used data from a government database. A difference-in-differences model was used to compare results from baseline data and the program period for Dhar District to similar data for the adjacent Jhabua District.ResultsThe program was well implemented and appreciated by patients and providers. Patients received an average of 10.2 home visits and 6.2 food baskets. While all age and sex groups gained weight significantly over their 6-month treatment period, there was no program impact on treatment retention. Seventy-six percent of patients achieved both outcome goals. And though average program costs were under budget, ChildFund experienced a loss in the results-based financing scheme, which was covered by USAID to continue program expansion.ConclusionsImplementing a nutrition supplementation and education program for TB patients in India is feasible. The intervention improved weight gain despite COVID-19-related lockdowns. The Mukti program did not impact treatment retention, which was already high at baseline. Program costs were modest, but the results-based financing reimbursement scheme resulted in a loss for the implementer. Overall, the RBF model led to an increased focus on outcomes for program staff and other stakeholders, which led to more efficient service delivery. Future research should examine total costs (including donated staff time) more extensively to determine the cost-effectiveness of Mukti and similar interventions.

Association between inpatient education program for patients with pre-dialysis chronic kidney disease and new-onset cardiovascular disease after initiating dialysis.

The association between inpatient education programs (IEPs) for patients with pre-dialysis chronic kidney disease (CKD) and new-onset cardiovascular disease (CVD) after initiating dialysis is unclear. We conducted a retrospective cohort study between January 1, 2011 and December 31, 2018, evaluating CKD patients who were divided into two groups based on whether or not they participated in IEPs. The primary outcome was a new-onset CVD event after initiating dialysis. Cumulative incidence function was used to describe new-onset CVD considering the competing outcome of death. Additionally, Cox proportional hazards models were used to estimate the hazard ratio of new-onset CVD between IEP and non-IEP groups. Of the 493 patients, 131 (26.6%) patients had participated in IEPs. The IEP group had a significantly longer duration of CKD management by nephrologists (median 142 vs. 115days, P = 0.007), lower rate of emergency hospital admissions (9.9% vs. 27.1%, P < 0.001), better ability to perform activities of daily living (Grade J; 81.6% vs. 69.1%, P = 0.046), higher rate of pre-placement of permanent vascular access or peritoneal dialysis catheters (82.4% vs. 59.4%, P < 0.001), and a higher serum albumin level at the beginning of dialysis (3.5 ± 0.5 vs. 3.3 ± 0.6g/dL, P < 0.001). The cumulative incidence of new-onset CVD at three years after initiating dialysis in the IEP and non-IEP groups was 16.9% and 22.5%, respectively. The hazard ratio for new-onset CVD after initiating dialysis in the IEP group was 0.63 (95% CI: 0.41-0.97, P = 0.036). IEPs were associated with a lower rate of new-onset CVD after initiating dialysis.

Nutrition and Diabetes Education Program for Older Diabetic Patients Through Telenutrition in Rural and Urban Communities in Honduras Using PRIDE (Partnership to Improve Diabetes Education) Tool Kit from Vanderbilt University

Nutrition and Diabetes Education Program for Older Diabetic Patients Through Telenutrition in Rural and Urban Communities in Honduras Using PRIDE (Partnership to Improve Diabetes Education) Tool Kit from Vanderbilt University

Workshop (Clinical/Best Practice Implementation) ID 2001167

Background Hamilton’s Spinal Cord Injury (SCI) Regional Rehabilitation Program in collaboration with SCI Consortium is implementing tissue integrity monitoring for pressure injury (PI) prevention. An increased prevalence of PI was found in 2021 - 2022 compared to 2020 on Hamilton’s SCI Rehabilitation Unit. To address this finding, the clinical team introduced a staff and patient education program focused on PI prevention. Upon completion of this workshop, the attendees will be aware of the CQI methodology used to implement the best practices related to tissue integrity and appreciate the education pathway for both staff and patients. Methods Using a Continuous Quality Improvement model, a systematic approach was used to enhance the education model for staff and patients on skin assessment and appropriate interventions. A process map was created outlining steps for each discipline involved in skin assessment, intervention, and patient education. Education plan included Skin &amp; Wound Management workshop, individual and group patient education, daily skin check calendar for patient/staff use. The workshop will be delivered in a lecture format, ending with discussion time. Results Preliminary data post partial implementation of the education program showed a decrease of 12% in the prevalence of PIs in the patients discharged from the program between July 2022 and March 2023 compared to January 2021 – June 2022. Conclusion Preliminary results are encouraging in demonstrating that implementation of a comprehensive education plan for staff and patients using a structured framework is effective in reducing the prevalence of pressure injuries in the inpatient SCI rehab unit.

Evaluation of drug treatment awareness among caregivers and patients of chronic kidney disease: unexplored determinant in patient care

Background: Chronic kidney disease (CKD) patients are prescribed multiple drugs to slow disease progression and prevent complications mandating adherence to therapy. Lack of awareness about drug treatment is one of the contributors to nonadherence. Hence the study was conducted to explore the awareness of patients and caregivers towards CKD treatment. Methods: The study was a cross sectional questionnaire-based study conducted among 300 CKD patients (150 dialysis/150 non-dialysis) and 100 caregivers (50 of dialysis / 50 of non-dialysis patients) attending nephrology OPD at a tertiary care hospital.Patient /caregiver awareness about drug treatment was assessed usinga prevalidated drug awareness questionnaire (8 items). The items were scored as correct response=2, no response=0 and incomplete response = -1, accounting the total awareness score as +20 to - 6 Results: The mean awareness score of patients / caregivers was 8.16±3.41 and 8.3±1.6 respectively. Majority (&gt;70%) patients/ caregivers gave accurate responses for the items -specifying number of medicines, medication frequency and regular intake of drugs but awareness regarding action plan for skipped (27% patients, 11% caregivers) or missed doses (22% patients, 15% caregivers) and adverse effects (17% patients, 5% caregivers) was poor. Patients/ caregivers belonging to dialysis group had statistically better awareness then non-dialysis group. Conclusions: Patient /caregiver awareness regarding drug treatment is less than 50% with strikingly low awareness about dose regimen, adverse effects, action plan for missed doses and co morbidities. Patient education programs to reinforce and retain this knowledge need to be implemented in CKD patients.

Impact d’un programme d’éducation thérapeutique du patient sur la qualité de vie d’enfants avec TDAH et celle de leurs parents

ObjectivesPatient education is a holistic therapeutic approach that focuses on the needs of individuals with a chronic condition and aims to improve quality of life. The patient education program “Living better with ADHD” is aimed at children and adolescents with ADHD from 8 to 14 years old and their parents. It consists of 5 themed group sessions and 2 semi-structured individual interviews. The aim of this study was to investigate the change in quality of life of the children and their parents who benefited from the program. Patients and methodThis is a prospective monocentric study of 35 families who participated in the “Living better with ADHD” program between February 2022 and July 2022 and completed the quality of life questionnaires KIDSCREEN-27 for children and WHOQOL-BREF for parents, pre-intervention and then 6 weeks later. ResultsThere was an improvement in the children's quality of life in the area of physical wellbeing and a trend towards an improvement in the quality of life in the “school environment”. This change was not correlated with any of the socio-demographic or clinical variables examined. On the other hand, there was no change in parental quality of life. ConclusionThese preliminary results suggest the value of therapeutic education for children with ADHD. Given the limitations of our method, randomized controlled trials should investigate the effects on quality of life for the long term.

Impact of therapeutic education on the evolution of social representations of medication in patients with Parkinson's disease: A quantitative and qualitative study (ETPARK REMED)

BackgroundAmong the workshops of our therapeutic patient education (TPE) program, the medication workshop (TPEM workshop) is very frequently proposed to patients in view of the difficulties they encounter related to the complexity of managing antiparkinsonian treatment. Patients’ appropriation of their medications could depend on their social representations. ObjectivesTo evaluate the effect of our TPEM workshop on the social representations PD patients have of their medications and to compare it with that of another therapeutic intervention such as a talking group defined as the control group. MethodsThis single-center, prospective, randomized, parallel-group study investigated the social representations of medication through a questionnaire on knowledge about antiparkinsonian medications, a questionnaire on beliefs about medication (BMQ), and a word association task. ResultsIn the TPEM group (n=16), the workshop induced significant effects over time on the knowledge questionnaire (P=0.01), BMQ specific necessity and concerns scores (P=0.04 and 0.01, respectively), necessity-concerns differential (P=0.04), and BMQ general harm (P=0.04). No significant difference was found in the talking group (n=6). Comparison of the two groups showed a significant difference of the BMQ general harm with a decrease in belief in the harmfulness of the medications in the workshop group (P=0.03). The results of the verbal association task showed a modification in the content and structure of the social representations of medication in the TPEM group. DiscussionThe TPEM workshop helped reduce initial negative aspects of medication representations. Improved knowledge of their medication allowed patients to feel more competent and legitimate in communicating with caregivers, modifying their beliefs about medications. Indeed, the medication was perceived as less restrictive, care becoming central as shown by the emergence of the medical team in the social representations of the medication. ConclusionAll the results show a specific beneficial effect of the TPEM workshop through an evolution of the social representations of medications, which became more positive in our PD patients.

Dry mouth in patients with a life-limiting condition or frailty: a study protocol for two intervention studies and a nested qualitative sub-study (the Dry mOuth Project, DROP)

BackgroundDespite its prevalent and impactful nature, dry mouth remains an underexposed and undertreated symptom in patients with a life-limiting condition or frailty. The main contributing factors are a lack of awareness and knowledge amongst both healthcare professionals and patients, and a scarcity of effective, evidence-based interventions. In the DRy mOuth Project (DROP), we address these factors by investigating both a non-pharmacological and a pharmacological intervention: a nurse-led patient education program and locally applied pilocarpine.MethodsThis intervention-based research project consists of two parallel studies. The non-pharmacological study is a cluster non-randomized controlled trial in 228 palliative nursing home and hospital patients, investigating the effect of structured use of guidelines and of patient education on dry mouth symptoms. This intervention, a nurse-led patient education program (the Mouth Education Program, MEP), will be compared to care as usual, the control. The pharmacological study is a double-blind placebo-controlled randomized trial that examines the effect of locally applied pilocarpine drops in 120 patients with dry mouth symptoms. Both studies use the same mixed-methods study design, in which the primary outcome is the clinical response to the intervention at 4 weeks, as measured by a dry mouth severity score (numeric rating scale from 0 to 10). Other outcomes, as measured by questionnaires over a 12-week follow-up period, include durability of the effect, impact on quality of life and, adherence and acceptability of the intervention. In addition, the feasibility and cost-effectiveness are evaluated by means of questionnaires and focus groups with healthcare professionals, and interviews with patients.DiscussionThis study investigates the effectiveness and feasibility of two interventions for dry mouth symptoms in patients with life-limiting conditions or frailty. Due to the large-scale and mixed-method nature of the study, this study will also improve our understanding of dry mouth and its relating factors and of the patients’ and healthcare professionals’ experiences with symptoms, care and guidelines of dry mouth, including any perceived barriers and facilitators.Trial registrationNCT05964959 & NCT05506137.

The Effects of a Tailored Dietary Education Program for Older Adult Patients on Hemodialysis: A Preliminary Study.

This study aimed to investigate the overall effects of a tailored dietary education program for older adult patients on hemodialysis (HD) based on self-efficacy theory, dietary knowledge and habits, nutritional intake, and biochemical parameters. A nonequivalent control group pre-test-post-test design was conducted for 8 weeks. The experimental and control groups received a weekly nutritional program and standard nursing care with an additional educational session, respectively. A clinical survey was conducted before and after the intervention. After the intervention, self-efficacy, dietary knowledge, and dietary habits were higher in the experimental group than in the control group. Moreover, carbohydrate, phosphorus, and sodium intake significantly decreased post-intervention in the experimental group but not in the control group. The dietary education program for older HD patients showed positive effects on boosting their self-efficacy, increasing dietary knowledge, improving dietary habits, and decreasing carbohydrate, calcium, phosphorus, and sodium intake.

The GLA:D® Canada program for knee and hip osteoarthritis: A comprehensive profile of program participants from 2017 to 2022.

The Good Life with osteoArthritis in Denmark (GLA:D®) program was implemented in Canada in 2017 with the aim of making treatment guideline-recommended care available to the 4 million Canadians with knee and hip osteoarthritis (OA). This report describes the GLA:D® Canada program, registry and data collection procedures, and summarizes the sociodemographic and clinical profile of participants with knee and hip OA to inform the scientific research community of the availability of these data for future investigations and collaborations. The GLA:D® program consists of three standardized components: a training course for health care providers, a group-based patient education and exercise therapy program, and a participant data registry. Patients seeking care for knee or hip OA symptoms and enrolling in GLA:D® are given the option to provide data to the GLA:D® Canada registry. Participants agreeing to provide data complete a pre-program survey and are followed up after 3-, and 12-months. Data collected on the pre-program and follow-up surveys include sociodemographic factors, clinical characteristics, health status measures, and objective physical function tests. These variables were selected to capture information across relevant health constructs and for future research investigations. At 2022 year-end, a total of 15,193 (11,228 knee; 3,965 hip) participants were included in the GLA:D® Canada registry with 7,527 (knee; 67.0%) and 2,798 (hip; 70.6%) providing pre-program data. Participants were 66 years of age on average, predominately female, and overweight or obese. Typically, participants had knee or hip problems for multiple years prior to initiating GLA:D®, multiple symptomatic knee and hip joints, and at least one medical comorbidity. Before starting the program, the average pain intensity was 5 out of 10, with approximately 2 out of 3 participants using pain medication and 1 in 3 participants reporting a desire to have joint surgery. Likewise, 9 out 10 participants report having previously been given a diagnosis of OA, with 9 out 10 also reporting having had a radiograph, of which approximately 87% reported the radiograph showed signs of OA. We have described the GLA:D® Canada program, registry and data collection procedures, and provided a detailed summary to date of the profiles of participants with knee and hip OA. These individual participant data have the potential to be linked with local health administrative data registries and comparatively assessed with other international GLA:D® registries. Researchers are invited to make use of these rich datasets and participate in collaborative endeavours to tackle questions of Canadian and global importance for a large and growing clinical population of individuals with hip and knee OA.

15 Development of a student-led cervical cancer patient education and navigation program

15 Development of a student-led cervical cancer patient education and navigation program

Improving Utilization of the Chemotherapy Unit through Implementing the Medication Early Release Project.

The outpatient oncology infusion unit is very busy, serving 60 to 70 patients per day. Due to a limited number of nurses, treatment chairs, only one pharmacy hood for bio-hazardous drug preparation, and other factors, patients wait a long time before starting their treatment, which affects the patient experience negatively. We conducted a quality improvement project to reduce the waiting time before starting the treatment, improve the patients' experience, and allow the unit to work more effectively through better resource utilization and accommodating more patients. A committee was formed with representatives from oncology nursing and the quality specialist, chemotherapy pharmacy supervisor, data manager, and a medical consultant (team leader). We studied baseline data of patient waiting times from January to March 2019 and the factors that contributed to delays before starting the treatment. The charge nurse identified patients who could safely have their medication released early in the morning at 7 am, enabling the pharmacy to dispense at 8 am without their actual presence being required in the infusion suite (i.e., medication early release program or MERP). Multiple plan-do-study-act (PDSA) cycles were implemented to achieve a wait time from check-in to medication administration of less than 60 minutes. Data collected included check-in time, chair time, vital signs time, administration time, and discharge time. Additionally, reasons for drug wastage were assessed for patients who did not receive the prepared medication. A patient satisfaction survey was conducted with the patients before and after being enrolled in the program. At baseline, average waiting time for patients receiving similar medications in the MERP was 2 hours and 27 minutes. After the first intervention, average waiting time was reduced to 1 hour and 24 minutes, and small improvements were observed after each PDSA cycl. A major breakthrough occurred after an intensive patient education program and enforcement of strict compliance with the criteria in selecting the patients appropriate for theMERP. Average waiting time wasreduced to ≤ 60 minutes, and in November 2022, it was 30 minutes on average. Drug wastage was identified as a balancing measure. We were successful in reducing drug wastage by implementing several changes and patient education measures and achieved zero wastage. The patient satisfaction survey showed better satisfaction with the new changes. A positive impact was achieved in this quality improvement project, with a significant reduction in the average waiting time for patients to start receiving chemotherapy. The outcome of this project has been maintained for 4 years and is still ongoing.

Improving secondary prevention knowledge in immigrants after a heart attack: adapting and evaluating a virtual patient education resource to promote behaviour change

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary heart disease (CHD) is prevalent and recurrent (40%), whereas an estimated 75% of events could be avoided by secondary prevention of modifiable risk factors and healthy lifestyle. Structured in-person secondary prevention and patient education programs are both efficient and effective strategies; however, these programs may not meet immigrants’ care or home-based learning needs, and thus alternative educational models are needed. Purpose To adapt and evaluate the simplified Chinese version of Cardiac College, a co-designed evidence-based virtual patient education resource for heart attack, in Chinese immigrants on secondary prevention knowledge and behaviour change outcomes. Methods A prospective longitudinal pre-post study was undertaken in heart attack survivors recruited from cardiac rehabilitation programs at four metropolitan tertiary hospitals from May 2021 to November 2022. Chinese Cardiac College intervention was adapted and provided education via nine booklets and 10 pre-recorded video sessions structured and delivered to patients for four weeks following hospital discharge. Validated surveys measured health literacy, disease-related knowledge, physical activity, heart-healthy diet, and self-management behaviours at baseline and one to two weeks post-intervention. Acceptability, engagement, and satisfaction were also assessed post-intervention. Results From 81 patients assessed for eligibility, 67 were recruited, and 64 (95.5%) completed the study. The sample was aged mean 67.23 ± 8.12 years, and 81.25% were males. Participants had significant improvement in disease-related knowledge in total and in each domain, with the most improvement identified in medical, followed by exercise and psychological domains (p&amp;lt;0.001) (Table 1). Healthy dietary behaviour and other self-management behaviours also significantly improved (all p&amp;lt;0.05). All participants (100%) self-reported being engaged with the materials, rating content as highly acceptable (n=20, 31.3%) and highly satisfactory (n=30, 46.9%). In addition, most participants reported that the delivered information amount was adequate (n=44, 68.8%), and 26.6% (n=17) found it overwhelming. Conclusion A virtual patient-education intervention adapted for Chinese immigrants (Chinese Cardiac College) significantly improves secondary prevention knowledge and self-care behaviour in heart attack survivors and offers a suitable model for intervention, especially where there are limited bilingual staff or resources. Further testing of randomised controlled trials and multiple populations is required.

INFORM-AF: a pilot-feasibility study of an mHealth atrial fibrillation education program

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (Australian Government) Objective to determine the feasibility and efficacy of a digital education program for patients living with atrial fibrillation on patient knowledge and AF-related quality of life. Methods a single-arm pilot-feasibility study was conducted. Participants with diagnosed AF were recruited from two metropolitan hospitals in Australia, following index hospitalisation. INFORM-AF was delivered by a QStream digital platform directly to participant’s smartphones over 6 weeks. The intervention consisted of a series of 6 interactive micro-learning case studies, multiple choice questions, instant feedback and learning resources delivered using a standardised spaced algorithm with repetition. Topics addressed AF symptoms, risk factors and complications, lifestyle and medication management and seeking assistance. Outcome measures included AF knowledge (JEKQ), AF quality of life (AFEQT) and system usability (SUS). Surveys were completed at in-hospital baseline and via phone at 6 weeks, 3, 6 and 12 months. Results 32 participants were enrolled, 2 were lost to follow up and 2 withdrew. 28 were included in the analyses. The mean age was 61 years (32-79 years), with 56% female. There were significant improvements to AF knowledge (62% pre vs 73% post, p&amp;lt;0.001) and AF quality of life at 6 weeks (54 pre and 68 post, p = 0.016), system usability was excellent (mean 84). Knowledge improvements were the greatest in the risk factor, symptom recognition, and when to seek assistance domains. Conclusion INFORM-AF demonstrated good feasibility with significant improvements in AF knowledge and quality of life at 12 months. We plan to evaluate this intervention in a larger clinical trial on outcomes including emergency department visits, hospitalisation and healthcare utilisation.Table 1Figure 1

User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study.

Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team-facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.

Un programme d’éducation thérapeutique pour l’initiation et le suivi d’un traitement par clozapine

Clozapine is the reference treatment for resistant schizophrenia. Although its efficacy has been widely demonstrated in numerous studies, it remains largely under-prescribed in its main indication. Therapeutic patient education (TPE) programs focused on clozapine could, on the one hand, promote the prescription of this drug and, on the other, encourage patients to adhere to the treatment schedule by improving their knowledge of its effectiveness. This article presents the TPE program entitled “Living with clozapine” developed to support the initiation and follow-up of patients being treated with clozapine.