Department of General Practice/Family Medicine, Philipps University of Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany.
Health Qual Life Outcomes. 2012 Jul 9;10:78. doi: 10.1186/1477-7525-10-78.
Coronary heart disease (CHD) is a common medical problem worldwide that demands shared care of general practitioners and cardiologists for concerned patients. In order to improve the cooperation between both medical specialists and to optimize evidence-based care, a treatment pathway for patients with CHD was developed and evaluated in a feasibility study according to the recommendation for the development and evaluation of complex interventions of the British Medical Research Council (MRC). In the context of this feasibility study the objective of the present research was to investigate the contributions of different disease related (e.g. prior myocardial infarction), pathway related (e.g. basic medication) and demographic variables on patients` perceived health related quality of life (HRQoL) as a relevant and widely used outcome measure in cardiac populations.
Data assessing demographic, disease and pathway related variables of CHD patients included in 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 and after 6 and 12 (intervention groups), and 9 months (control group), respectively after the initial implementation on GP level. Additionally, at the same measuring points the CHD patients participating in the study were interviewed by phone regarding their perceived HRQoL, measured with the EuroQol EQ-5D as an index-based health questionnaire. Due to the hierarchical structure of the data, we performed cross-sectional and longitudinal linear mixed models to investigate the impact of disease related, pathway related and demographic variables on patients` perceived HRQoL.
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. At all assessment points, patients` HRQoL was associated with a variety of sociodemographic variables (e.g. gender, employment, education) in each study group, but there was no association with pathway related variables. In both cross-sectional and longitudinal analyses highest HRQoL values in patients were reported in the physician group that had developed the pathway. In the longitudinal analyses there were no significant changes in the reported HRQoL values of the three groups over time.
The found associations between sociodemographic variables and the perceived HRQoL of patients with CHD are in line with other research. As there are no associations of HRQoL with pathway related variables like the basic medication, possible weaknesses in the study design or the choice of outcome have to be considered before planning and conducting an evaluation study according to the MRC recommendations. Additionally, as patients in the developer group reported the highest HRQoL values over time, a higher commitment of the GPs in the developer group can be assumed and should be considered in further research.
冠心病（CHD）是一种常见的全球性医学问题，需要全科医生和心脏病专家共同关注患者。为了改善这两个医学专业之间的合作，并优化基于证据的护理，根据英国医学研究理事会（MRC）制定和评估复杂干预措施的建议，制定了冠心病患者的治疗途径，并在一项可行性研究中进行了评估。在这项可行性研究的背景下，本研究的目的是调查不同疾病相关（例如先前的心肌梗死）、途径相关（例如基本药物）和人口统计学变量对患者感知的健康相关生活质量（HRQoL）的贡献，因为 HRQoL 是心脏人群中常用的一种相关结果测量。
通过病例记录表格和问卷，在一个准实验设计中，在三个研究组（途径开发者、使用者、对照组）中收集了包括在研究中的冠心病患者的人口统计学、疾病和途径相关变量的数据，基线和 6 个月和 12 个月（干预组），以及 9 个月（对照组）后，GP 级别的初始实施后分别进行了评估。此外，在同一测量点，研究中的冠心病患者通过电话接受了他们感知的 HRQoL 的访谈，使用 EuroQol EQ-5D 作为基于索引的健康问卷进行测量。由于数据的层次结构，我们进行了横断面和纵向线性混合模型分析，以调查疾病相关、途径相关和人口统计学变量对患者感知 HRQoL 的影响。
在最初招募的 334 名冠心病患者中，共有 290 名患者纳入了我们的分析。从基线评估到 12 个月随访，这是一个平均 13.2%的失访率。在所有评估点，患者的 HRQoL 与各研究组的各种社会人口统计学变量（例如性别、就业、教育）相关，但与途径相关变量无关。在横断面和纵向分析中，在制定途径的医生组中，患者报告的 HRQoL 值最高。在纵向分析中，三组的报告 HRQoL 值在整个研究过程中没有随时间显著变化。
与冠心病患者感知的 HRQoL 相关的社会人口统计学变量的发现关联与其他研究一致。由于 HRQoL 与基本药物等途径相关变量无关，因此在根据 MRC 建议进行规划和开展评估研究之前，必须考虑研究设计或结果选择的可能弱点。此外，由于开发人员组中的患者随着时间的推移报告了最高的 HRQoL 值，因此可以假设全科医生在开发人员组中的承诺更高，应在进一步的研究中考虑这一点。
