Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2006

Open Access 01-12-2006 | Research article

Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study

Authors: Julie Redfern, Elizabeth Ellis, Tom Briffa, Saul B Freedman

Published in: BMC Health Services Research | Issue 1/2006

Login to get access

Abstract

Background

Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modules and corresponding patient information leaflets for secondary prevention of CHD.

Methods

In phase one, a series of risk factor modules and management options were developed following analysis of literature and interviews with health professionals. In phase two, module information leaflets were developed using published guidelines and interviews of people with CHD. In phase three, the leaflets were tested for quality (DISCERN), readability (Flesch) and suitability (SAM) and were compared to the existing cardiac rehabilitation (CR) information leaflet. Finally, the patients assessed the leaflets for content and relevance.

Results

Four key risk factors identified were cholesterol, blood pressure, smoking and physical inactivity. Choice management options were selected for each risk factor and included medical consultation, intensive health professional led program, home program and self direction. Patient information needs were then identified and leaflets were developed. DISCERN quality scores were high for cholesterol (62/80), blood pressure (59/80), smoking (62/80) and physical activity (62/80), all scoring 4/5 for overall rating. The mean Flesch readability score was 75, representing "fairly easy to read", all leaflets scored in the superior category for suitability and were reported to be easy to understand, useful and motivating by persons with CHD risk factors. The developed leaflets scored higher on each assessment than the existing CR leaflets.

Conclusion

Using a progressive three phase approach, a series of risk factor modules and information leaflets were successfully developed and tested. The leaflets will contribute to shared-decision making and empowerment for persons with CHD.
Literature
1.
Miller WR, Rollnick S: Motivational Interviewing – Preparing people for change. 2002, New York: The Guilford Press, 2
2.
Rossouw JE, Lewis B, Rifkind BM: The value of lowering blood cholesterol after myocardial infarction. N Engl J Med. 1990, 323: 1112-1119.PubMedCrossRef
3.
Gordon NF, Haskell WL: Comprehensive cardiovascular disease risk reduction in a cardiac rehabilitation setting. Am J Cardiol. 1997, 80: 69H-73H. 10.1016/S0002-9149(97)00825-4.PubMedCrossRef
4.
McAlister FA, Lawson FME, Teo KK, Armstrong PW: Randomised trials of secondary prevention programs in coronary heart disease: systematic review. Br Med J. 2001, 323: 957-962. 10.1136/bmj.323.7319.957.CrossRef
5.
Aroney C, Boyden A, Jelinek M, Thompson P, Tonkin A, White H: Management of unstable angina, Guidelines – 2000. Med J Aust. 2000, 173: S65-S88.
6.
WHO-ISH – The Guidelines Subcommittee of the WHO-ISH Mild Hypertension Liason Committee: Guidelines for the management of mild hypertension. Memorandum from the World Health Organisation – International Society of Hypertension Meeting. J Hypertens. 1993, 11: 905-918.CrossRef
7.
Bunker S, McBurney H, Cox H, Jelinek M: Identifying participation rates at outpatient cardiac rehabilitation programs in Victoria, Australia. J Cardiopulm Rehab. 1999, 19: 334-8. 10.1097/00008483-199911000-00001.CrossRef
8.
Scott IA, Lindsay KA, Harden HE: Utilisation of outpatient cardiac rehabilitation in Queensland. Med J Aust. 2003, 179: 341-345.PubMedCrossRef
9.
Bethell HJ, Turner SC, Evans JA, Rose L: Cardiac Rehabilitation in the United Kingdom. How complete is the provision?. J Cardiopulm Rehab. 2001, 21: 111-115. 10.1097/00008483-200103000-00008.CrossRef
10.
Harlan WR, Sandler SA, Lee KL, Lam LC, Mark DB: Importance of baseline functional and socioeconomic factors for participation in cardiac rehabilitation. Am J Cardiol. 1995, 76: 36-39. 10.1016/S0002-9149(99)80797-8.PubMedCrossRef
11.
Thomas RJ, Miller NH, Lamendola C, Berra K, Hedback B, Durstine JL, Haskell W: National survey on gender differences in cardiac rehabilitation programs: patient characteristics and enrollment patterns. J Cardiopulm Rehabil. 1996, 16: 402-12. 10.1097/00008483-199611000-00010.PubMedCrossRef
12.
Briffa T: Costs and benfits of existing and new cardiac rehabilitation strategies. PhD Thesis. 2000, Faculty of Medicine, University of Sydney
13.
Merz CNB, Rozanski A: Remodeling cardiac rehabilitation into secondary prevention programs. Am Heart J. 1995, 132: 418-427.CrossRef
14.
Turnball A: How nurses can develop good patient information leaflets. Nurs Times. 2003, 99: 26-27.
15.
Coulter A: Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy. 1997, 2: 112-121.PubMedCrossRef
16.
Rollnick S, Allison J, Ballasiotes , Barth T, Butler CC, Rose GS, Rosengren DB: Variations on a theme: motivational interviewing and its adaptations (Chap 18). Motivational Interviewing – Preparing people for change. Edited by: Miller WR, Rollnick S. 2002, New York: The Guilford Press, 2
17.
Coulter A, Entwistle V, Gilbert D: Informing patients: An Assessment of the Quality of Patient Information Material. 1998, London: King's Fund
18.
Schulman BA: Active patient orientation and outcomes in hypertensive treatment. Med Care. 1979, 17: 267-280. 10.1097/00005650-197903000-00004.PubMedCrossRef
19.
Simpson M, Buckman R, Stewart M, Maguire P, Lipkin M, Novack D, Till J: Doctor-patient communication: the Toronto consensus statement 1991.
20.
Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC: Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989, 4: 506-511.PubMedCrossRef
21.
22.
Roter DL: Patient participation in patient provider interaction: the effects of patient question-asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr. 1997, 5: 281-315.CrossRef
23.
Kaplan SH, Greenfield S, Ware JE: Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989, 27: S110-S127. 10.1097/00005650-198903001-00010.PubMedCrossRef
24.
Etchells E: A safe, effective adjunctive treatment for arthritis, and pretty much every other condition you'll ever treat. J Rheumatol. 1999, 26: 1647-1649.PubMed
25.
26.
Barlow JH, Pennington DC, Bishop P: Patient education leaflets for people with rheumatoid arthritis. Psychol Health Med. 1997, 2: 221-235.CrossRef
27.
Hill J, Bird HA, Harmer R, Lawton C, Wright V: An evaluation of the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Br J Rheumatol. 1994, 33: 283-288.PubMedCrossRef
28.
Humphris GM, Duncalf M, Holt D, Field FA: The experimental evaluation of an oral cancer information leaflet. Oral Oncol. 1999, 35: 575-582. 10.1016/S1368-8375(99)00040-8.PubMedCrossRef
29.
Michie S, Rosebert C, Heaversedge : The effects of different kinds of information on women attending an out-patient breast clinic. Psychol Health Med. 1996, 1: 285-396.CrossRef
30.
Davison BJ, Kirk P, Degner LF, Hassard TH: Information and patient participation in screening for prostate cancer. Patient Educ Counsel. 1999, 37: 255-263. 10.1016/S0738-3991(98)00123-2.CrossRef
31.
32.
Centre for Health Information Quality: Quality issues in consumer health information. Reports from three quality forums held at the launch of the centre for health information Quality, Report Series 1, Centre for Health Information Quality: Winchester 1997. Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend? Patient Educ Couns. Edited by: Rees CE, Ford JE, Sheard CE. 2003, 49: 263-272.
33.
Rienzo BA, Vitello EM: Development of patient education resource materials – A planned strategy. J Am Coll Health Assoc. 1978, 27: 224-225.CrossRef
34.
Coulter A: Evidence based patient information: Is important, so there needs to be a national strategy to ensure it. Br Med J. 1998, 317: 225-226.CrossRef
35.
Scotland A: Towards readability and style. Community Med. 1985, 7: 126-132.PubMed
36.
Hill J, Bird H: The development and evaluation of a drug information leaflet for patients with rheumatoid arthritis. Rheumatology. 2003, 42: 66-70. 10.1093/rheumatology/keg032.PubMedCrossRef
37.
Wilson F: The suitability of United States pharmacopoeia dispensary information psychotropic drug leaflets for urban patients with limited reading skills. Arch Psychiatr Nurs. 1999, 13: 204-211. 10.1016/S0883-9417(99)80006-5.PubMedCrossRef
38.
Rees CE, Ford JE, Sheard CE: Patient information leaflets for prostate cancer: which leaflets should healthcare professionals recommend?. Patient Educ Counsel. 2003, 49: 263-272. 10.1016/S0738-3991(02)00188-X.CrossRef
39.
Smith H, Gooding S, Brown R, Frew A: Evaluation of readability and accuracy of information leaflets in general practice for patients with asthma. Br Med J. 1998, 317: 264-265.CrossRef
40.
Smith PT, Cason CL: Suitability of patient education materials for cardiac catheterization. Clin Nurse Spec. 1998, 12: 140-144. 10.1097/00002800-199807000-00006.PubMedCrossRef
41.
Bhopal RS, Gilmour WH, Fallon CW, Bhopal JS, Hamilton I: Evaluation of a practice information leaflet. Fam Pract. 1990, 7: 132-137.PubMedCrossRef
42.
Joshi HB, Newns N, Stainthorpe A, Macdonagh RP, Keeley FX, Timoney AG: The development and validation of a patient-information booklet on ureteric stents. Br J Urol. 2001, 88: 329-334.CrossRef
43.
Zakrzewska JM, Leeson RM, McLuskey M, Vickers M: The development of patient information leaflets. Care of the mouth afterradiotherapy. Gerodontology. 1997, 14: 48-53. 10.1111/j.1741-2358.1997.00048.x.PubMedCrossRef
44.
Charnock D, Shepperd S, Needham G, Gann R: DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health. 1999, 53: 105-111.PubMedPubMedCentralCrossRef
45.
Godolphin W, Towle A, McKendry R: Evaluation of the quality of patient information to support informed shared decision-making. Health Expect. 2001, 4: 235-242. 10.1046/j.1369-6513.2001.00144.x.PubMedPubMedCentralCrossRef
46.
Rees CE, Ford JE, Sheard CE: Evaluating the reliability of DISCERN: a tool for assessing the quality of written patient information on treatment choices. Patient Educ Counsel. 2002, 47: 273-275. 10.1016/S0738-3991(01)00225-7.CrossRef
47.
48.
Scott JT, Thompson DR: Assessing the information needs of post-myocardial infarction patients: a systematic review. Patient Educ Couns. 2003, 50: 167-177.PubMedCrossRef
49.
Meade CD, Smith CF: Readability formulas: Cautions and criteria. Patient Educ Counsel. 1991, 17: 153-158. 10.1016/0738-3991(91)90017-Y.CrossRef
50.
51.
Simes JC, Marschener IC, Hunt D, Colquhoun D, Sullivan D, Stewart RA, Hague W, Keech A, Thompson P, White H, Shaw J, Tonkin A, LIPID Study Investigators: Relationship between lipid levels and clinical outcomes in the Long-Term Intervention with pravastatin in ischaemic Disease (LIPID) Trial: To what extent is the reduction in coronary events with pravastatin explained by on-study lipid levels?. Circulation. 2002, 105: 1162-1169. 10.1161/hc1002.105136.PubMedCrossRef
52.
MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J: Blood pressure, stroke and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies connected for the regression dilution bias. Lancet. 1990, 335: 765-774. 10.1016/0140-6736(90)90878-9.PubMedCrossRef
53.
Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CH: Blood pressure, stroke and coronary heart disease. Part 2. Short-term reductions in blood pressure. Overview of randomised drug trials in their epidemiologic context. Lancet. 1990, 335: 827-838. 10.1016/0140-6736(90)90944-Z.PubMedCrossRef
54.
Australian Institute of Health and Welfare (AIHW): Heart, stroke and vascular diseases – Australian facts 2004. 2004, AIHW Cat. No. CVD 27. Canberra: AIHW
55.
Hurley SF: Short-term impact of smoking cessation on myocardial infarction and stroke hospitalizations and costs in Australia. Med J Aust. 2005, 183: 13-17.PubMedCrossRef
56.
Blair SN, Kohl HW, Paffenbarger RS, Clark DG, Cooper KH, Gibbons LW: Physical fitness and all-cause mortality: A prospective study of men and women. JAMA. 1989, 262: 2395-2401. 10.1001/jama.262.17.2395.PubMedCrossRef
57.
Doak CC, Doak LG, Root JH: Teaching patients with low literacy kills. 1996, Philadelphia USA: Saunders, 2
Metadata
Title
Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study
Authors
Julie Redfern
Elizabeth Ellis
Tom Briffa
Saul B Freedman
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2006
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-6-95

Other articles of this Issue 1/2006

BMC Health Services Research 1/2006 Go to the issue

Research article

Identifying patients at risk of nursing home admission: The Leeds Elderly Assessment Dependency Screening tool (LEADS)

Research article

REFERQUAL: a pilot study of a new service quality assessment instrument in the GP exercise referral scheme setting

Research article

A rational model for assessing and evaluating complex interventions in health care

Research article

Association of socio-economic status with diabetes prevalence and utilization of diabetes care services

Research article

Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

Study protocol

The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee