The Effect of Problem-based Learning After Coronary Heart Disease - a Randomised Study in Primary Health Care (COR-PRIM)

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2020 Aug 16

PMID 32795267

Citations 7

Authors

Anita Karner Kohler

Tiny Jaarsma

Pia Tingstrom

Staffan Nilsson

Affiliations

Soon will be listed here.

Abstract

Background: Cardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients' empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.

Methods: Patients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age. 68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.

Results: At one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls.

Conclusions: The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.

Trial Registration: NCT01462799 (February 2020).

Citing Articles

Compliance Behaviour After a Coronary Ischaemic Event: A Quasi-Experimental Study of Adherence to a Protocolised Follow-Up in Primary Care.

Lizcano-Alvarez A, Carretero-Julian L, Talavera-Saez A, Alameda-Cuesta A, Rodriguez-Vazquez R, Cristobal-Zarate B J Cardiovasc Dev Dis. 2024; 11(12).

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Cognition of diet quality and dietary management in elderly patients with coronary and other atherosclerotic vascular disease in western China, a qualitative research study.

Chen J, Li X, Wang Y, Zhang C, Yang L, Zhao L BMC Geriatr. 2024; 24(1):525.

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Intensive nurse-led follow-up in primary care to improve self-management and compliance behaviour after myocardial infarction.

Lizcano-Alvarez A, Carretero-Julian L, Talavera-Saez A, Cristobal-Zarate B, Cid-Exposito M, Alameda-Cuesta A Nurs Open. 2023; 10(8):5211-5224.

PMID: 37084014 PMC: 10333842. DOI: 10.1002/nop2.1758.

Effect of Patient-Empowerment Interaction Model on Self-Management Ability of Peritoneal Dialysis Patients: A Randomized Controlled Trial.

Cao F, Hong F, Ruan Y, Lin M Patient Prefer Adherence. 2023; 17:873-881.

PMID: 37009428 PMC: 10065006. DOI: 10.2147/PPA.S402698.

Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM).

Andreae C, Tingstrom P, Nilsson S, Jaarsma T, Karlsson N, Karner Kohler A BMJ Open. 2023; 13(2):e065230.

PMID: 36828650 PMC: 9972427. DOI: 10.1136/bmjopen-2022-065230.

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