Paper
Wednesday, July 11, 2007
Promoting patients' knowledge for disease management and self care and utilization of health services
Orly Toren, RN, PhD, Nursing division, Chaim Sheba Medical Center, Tel Hashomer, Israel, Hana Kerzman, RN, PhD, Nursing Division, The Chaim Sheba Medical Center, Tel Hashomer, Israel, and Orna Baron Epel, Phd, School of Public Health, Faculty of Social Welfare and Health Studies, Haifa University, Haifa, Israel.
| Learning Objective #1: learn about the effect of discharge program on utilization of health services in the community and in hospital setting |
| Learning Objective #2: learn about the effect of discharge program on subjective health perception among cardiovascular patients |
Introduction: One of the main challenges of the health care system today is to raise patient's knowledge prior to hospital discharge to prepare him for better self care in the community. Lack of knowledge may lead to increased utilization of health care services in the long term.
Purpose: To evaluate a new structured intervention plan prior to hospital discharge and the use of health care services and subjective health perception: a three year follow-up among cardiovascular patients.
Methodology: A prospective intervention study, a week, month and two years follow-up of cardiovascular patients discharged from internal medicine wards. Patients in control group received counseling generally delivered, patients in intervention group received individual counseling with a structured program focusing on self care and disease management, delivered by specially trained nurses). Data was collected via telephone interviews regarding community services, and subjective health perception. Information regarding emergency services and re-hospitalizations were collected from data bases
Findings: 143 patients (71 control, 72 intervention) participated in the study. Patients receiving individual counseling perceived their health better than patients in the control group in the short term (p< .002) and long term (p< .1). Visit rates to the ER were four times lower in the intervention group (2.2%) than in the control group (7.8%) (p. < .007). No differences were found between the two groups regarding utilization of health services in the community. Survival analyses indicated that the time from discharge to the first ER visit was shorter in the control group.
Conclusion: Based on the fact that there is no stated policy for initiated medical follow-up visits in the community, using directed knowledge about self care patients tend to use variety of health services. This trend may indicate greater awareness for physical condition and self care.