Paper
Wednesday, July 11, 2007
The effects of a structured intervention program at discharge for cardiovascular patients–A three-year follow up of quality-of-life effects
Hana Kerzman, RN, PhD, Nursing Division, The Chaim Sheba Medical Center, Tel Hashomer, Israel, Orly Toren, RN, PhD, Nursing division, Chaim Sheba Medical Center, Tel Hashomer, Israel, Tammy Yerushalmi-Lavi, BA, Nursing division, Tel Hashomer, Ramat Gan, Israel, and Orna Baron Epel, PhD, MPH, School of Public Health Faculty of Social Welfare and Health, Haifa University, haifa, Israel.
| Learning Objective #1: The learner will be able to learn about The effects of a structured intervention program at discharge for cardiovascular patients in short and long term |
| Learning Objective #2: The learner will be learn about structured plan - discharge plan model |
Discharge planning is regarded as an essential component in quality of care due to changes in the health care system. These changes include shortening of hospital stay and transfer of treatments from hospital to the community.
Purpose: To examine the sustainability of the effectiveness of a discharge program regarding cardiovascular patients’ quality of life (QOL).
Methodology: A week, month and three-year follow-up of a prospective intervention study conducted with cardiovascular patients discharged from internal medicine wards. Patients were randomly assigned into two groups: Control (standard counseling) and Intervention (individual counseling with a structured program focusing on self-care, delivered by specially trained nurses). Data were collected via telephone interviews regarding quality of life (SF-36).
Findings: Among the 202 patients, who participated in the original study (a week and month after discharge), 143 patients (71 control, 72 intervention) were interviewed three years after discharge. The average age was 70±11.5 in the control and 71±11.6 in the intervention group. About 62% of the sample were men. Patients who had received individual counseling reported higher quality of life in the short and long term when compared to the control group regarding the following components: General health (p=0.1), Bodily pain (p=0.06), Role limitations due to physical health problems (p=0.1) and Social functioning (p=0.02). Both groups demonstrated improvement in Role limitations due to physical health problems and decline in Role limitations due to emotional problems over time. Participants in the intervention group demonstrated better Physical Component Summary than did the control group one week after discharge (p=0.03) as well as at each successive time internal (p<0.0001)
Conclusion: Structured discharge plans can help patients to better understand their medical condition and to learn ways of self-care. They thereby provide patients with the confidence to cope with disease and thus affect their short and long-term quality of life.