Background:
Coronory heart disease (CHD) is a common medical problem worldwide that demands sharedcare of general practitioners and cardiologists for concerned patients. In order to improve thecooperation between both medical specialists and to optimize evidence-based care, atreatment pathway for patients with CHD was developed and evaluated in a feasibility studyaccording to the recommendation for the development and evaluation of complexinterventions of the British Medical Research Council (MRC). In the context of thisfeasibility study the objective of the present research was to investigate the contributions ofdifferent disease related (e.g. prior myocardial infarction), pathway related (e.g. basicmedication) and demographic variables on patients` perceived health related quality of life(HRQoL) as a relevant and widely used outcome measure in cardiac populations.
Methods:
Data assessing demographic, disease and pathway related variables of CHD patients includedin the study were collected in a quasi-experimental design with three study arms (pathway developers, users, control group) via case record forms and questionnaires at baseline andafter 6 and 12 (intervention groups), and 9 months (control group), respectively after theinitial implementation on GP level. Additionally, at the same measuring points the CHDpatients participating in the study were interviewed by phone regarding their perceivedHRQoL, measured with the EuroQol EQ-5D as an index-based health questionnaire. Due tothe hierarchical structure of the data, we performed cross-sectional and longitudinal linearmixed models to investigate the impact of disease related, pathway related and demographicvariables on patients` perceived HRQoL
Results:
Of 334 initially recruited patients with CHD, a total of 290 were included in our analysis.This was an average 13.2 % dropout rate from baseline assessment to the 12-month follow-up(n = 44). At all assessment points, patients` HRQoL was associated with a variety ofsociodemographic variables (e.g. gender, employment, education) in each study group, butthere was no association with pathway related variables. In both cross-sectional andlongitudinal analyses highest HRQoL values in patients were reported in the physician groupthat had developed the pathway. In the longitudinal analyses there were no significantchanges in the reported HRQoL values of the three groups over time.
Conclusions:
The found associations between sociodemographic variables and the perceived HRQoL ofpatients with CHD are in line with other research. As there are no associations of HRQoLwith pathway related variables like the basic medication, possible weaknesses in the studydesign or the choice of outcome have to be considered before planning and conducting anevaluation study according to the MRC recommendations. Additionally, as patients in thedeveloper group reported the highest HRQoL values over time a higher commitment of theGPs in the developer group can be assumed and should be considered in further research.