Continuity of cardiac care: Cardiac rehabilitation participation and other correlates

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Abstract

Background

Continuity of care refers to the ongoing management of a patient's care over time and across practitioners, and the patient's experience of this care as coherent and consistent with their medical needs and context. Continuity of cardiac care is integral to secondary prevention and improved health outcomes.

Design

This study examined patient perceptions of continuity, and how they relate to cardiac rehabilitation participation and other correlates.

Methods

Consecutive acute coronary syndrome patients at 3 hospitals were approached, and 661 consented to complete a survey (504 men, 157 women; 75% response rate). Nine months later, 506 participants completed a survey including the Heart Continuity of Care Questionnaire, open-ended continuity perceptions, and self-reported cardiac rehabilitation participation (yes/no).

Results

The mean continuity perceptions were highly positive, and were equivalent to those found in another Canadian province, although open-ended responses revealed discontinuity with regard to outpatient visits and pharmacotherapy prescriptions. In a multivariate model (p = .003), the correlates of greater perceptions of continuity of cardiac care 9 months post-discharge were cardiac rehabilitation participation (p < .05), greater tangible support (p < .05), and less serious perceptions of illness consequences (p < .001) at the time of the acute coronary syndrome, after controlling for demographic and clinical factors.

Conclusion

Given the benefits of continuity of care, it is important to promote cardiac rehabilitation participation, a significant correlate of continuity, and to solicit various supports throughout the process of cardiac recovery.

Introduction

Continuity of care refers to the ongoing management of a patient's care over time and across practitioners, and the patient's experience of this care as coherent and consistent with their medical needs and context [1]. Continuity of care can improve the management of patient care between health care providers [2], [3], [4], increase efficiency and cost-effectiveness within the health care system [5], [6], [7], and decrease duplication of treatments [8]. Continuity of care has been shown to have beneficial effects on patient satisfaction [4], [9], patient self-management, and most importantly on health outcomes [10], [11]. When assessing continuity of care, it is important to incorporate patient perceptions [12], as it has been demonstrated that self-reported continuity of care is strongly associated with higher patient satisfaction [9].

Continuity of care may enable ongoing cardiac risk factor reduction. Although continuity of care has been investigated in a variety of patient populations [13], [14], the relationship between continuity and perceptions of care has received less attention in cardiac patients [15], [16]. This study examined patient perceptions of continuity of care, and how they relate to cardiac rehabilitation participation and other potential correlates of continuity. Cardiac rehabilitation is an integral component of the care continuum for cardiac patients, and is supported through clinical practice guideline recommendations [5], [17], [18]. These disease-specific education and behavior change programs are intended to provide cardiac rehabilitation participants with the necessary information to manage and reduce their risk, improve their health, and potentially ameliorate their continuity of care with specialists and primary care over time. The relationships between social support [19] and illness perceptions [20] and cardiac rehabilitation participation have been investigated. These concepts deserve exploration within a cardiac sample to increase our understanding of their impact on perceptions of continuity of care.

The objectives of this study were: (1) to describe continuity perceptions in a Canadian sample of cardiac patients under universal healthcare, (2) to compare these perceptions to those in another province, and (3) to investigate the correlates of positive continuity perceptions. It was hypothesized that cardiac rehabilitation participation, illness perceptions, and greater social support would have a positive impact on perceptions of continuity. By identifying the correlates of perceptions of continuity of care, secondary prevention may be improved by incorporating these findings into the care continuum for cardiac patients.

Section snippets

Procedure and design

Ethics approval was obtained from participating institutions. This study constitutes a longitudinal component of a larger prospective study on cardiac rehabilitation referral models [21]. Participants were recruited from three hospitals, namely the Trillium Health Centre (THC) and University Health Network (UHN: Toronto General and Toronto Western Hospitals), all large, urban tertiary care facilities in the Greater Toronto Area, Ontario, Canada, within a universal health coverage system.

Perceptions of continuity of care

Mean Heart Continuity of Care Questionnaire subscale scores are shown in Table 3. The mean and standard deviation of the total continuity of care score for the current sample was 3.89 ± 0.57. Heart Continuity of Care Questionnaire data from the current study were compared with the results obtained by Hadjistavropoulos et al. [23]. Significance tests were used to evaluate the equivalence of subscale scores between the two study populations [28]. The equivalency test statistic for the domains of

Discussion

This study prospectively examined patient perceptions of continuity of care in a large multi-site sample of patients hospitalized for an acute coronary event or procedure. Overall, the participant's perceptions of the continuity of care received were quite positive in all domains of informational, management, and relational continuity. The analysis of qualitative, coded items exemplified some of these perceptions of continuity of care in cardiac patients, and despite the high mean scores on the

Acknowledgements

We gratefully acknowledge the efforts of Suzan Krepostman and Laura Ewart in patient recruitment.

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    Support: We acknowledge funding for this project from the Canadian Health Services Foundation, the Ontario Ministry of Health and Long-Term Care, Canadian Institutes of Health Research. Dana Riley has career support from the Heart and Stroke Foundation of Ontario, and Sherry Grace support from the Ontario Ministry of Health and Long-Term Care.

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