Institute of Health Sciences, University of Opole, Poland.
Department of Family Medicine, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2023 Oct;32(10):1159-1166. doi: 10.17219/acem/161462.
Patients with cardiovascular disease (CVD) have an increased need for medical care and a high risk of hospitalization. It is necessary to improve the integration between healthcare, long-term care and social care for these individuals, as poor integration limits the full potential of care.
This study aims to identify effective indicators of CVD management, including variables that promote the horizontal and vertical integration of planned interventions.
Patients with chronic CVD managed by a general practitioner (GP) or a primary care cardiologist will be enrolled in the study. The study will use the World Health Organization Quality of Life Questionnaire (WHOQOL)-BREF, the Health Behavior Inventory (HBI) questionnaire, the Camberwell Assessment of Need (CAN) Short Appraisal Schedule, the Hospital Anxiety and Depression Scale-Modified Version (HADS-M), a Self-Description Questionnaire, and the authors' self-prepared questionnaire to collect data.
The main results will allow for the identification of the variables that influence the effectiveness of healthcare (understood as the synergy of high quality of life, intensification of health behaviors and high satisfaction of needs) for patients with CVD. In addition, an examination of the relationships between quality of life and health behaviors, assessment of needs (health and social), level of religiosity and spirituality, expectations, and variables affecting anxiety and depressive symptoms will allow for the identification of indicators that favor the integration of care both horizontally and vertically.
The results of this study will support the development of systems aimed at identifying CVD patients at risk for lower effectiveness of care in integrated care. In addition, the results may help to develop clinical information and decision support systems aimed at designing personalized care models for patients with CVD. They may also help to develop coordinated care plans and patient education programs, and obtain data useful for implementing system changes.
心血管疾病（CVD）患者对医疗保健的需求增加，住院风险高。有必要改善这些患者的医疗保健、长期护理和社会护理之间的整合，因为较差的整合限制了护理的全部潜力。
本研究旨在确定 CVD 管理的有效指标，包括促进计划干预横向和纵向整合的变量。
将招募由全科医生（GP）或初级保健心脏病专家管理的慢性 CVD 患者参加研究。研究将使用世界卫生组织生活质量问卷（WHOQOL）-BREF、健康行为问卷（HBI）、Camberwell 需求评估（CAN）简短评估计划、医院焦虑和抑郁量表修订版（HADS-M）、自我描述问卷和作者自己准备的问卷来收集数据。
主要结果将能够确定影响 CVD 患者医疗保健效果的变量（被理解为高质量生活、健康行为强化和需求高度满足的协同作用）。此外，对生活质量和健康行为之间的关系、需求评估（健康和社会）、宗教信仰和精神水平、期望以及影响焦虑和抑郁症状的变量进行评估，将能够确定有利于护理水平横向和纵向整合的指标。
本研究的结果将支持开发旨在识别在综合护理中护理效果较低风险的 CVD 患者的系统。此外，研究结果可能有助于开发针对 CVD 患者的临床信息和决策支持系统，旨在设计个性化护理模式。它们还可能有助于制定协调的护理计划和患者教育计划，并获得实施系统变革有用的数据。
