A three-step approach to supporting patient self-management in clinical practice
The aim of this project is to develop, evaluate, and multicentre implement a blended form of cardiac rehabilitation that uses a theory-based approach to guide patients to full self-management.
- Veronica Janssen
Despite the proven effectivity, participation in cardiac rehabilitation is low. A recent study showed that only 28% of Dutch patients who have an indication according to the guidelines participates in such a programme (Van Engen – Verheul et al., 2012). Women and elderly people appear to participate less often, as well as patients with comorbid problems and patients who have to travel further to the rehabilitation centre. Some patients discontinue the rehabilitation programme because they want to resume work.
A second problem is that the majority of patients who do participate, find it difficult to maintain the lifestyle changes after rehabilitation; relapse percentages up to 60% in the first six months have been reported (Mittag et al., 2006; Kotseva et al., 2004). More than 80% of the centres for cardiac rehabilitation in the Netherlands score insufficiently on adequately promoting a healthy lifestyle. (Inspectie voor de Volksgezondheid (Inspection for Public Health), 2012). The Inspection for Public Health exerts pressure on hospitals and cardiac rehabilitation centres in the Netherlands to (a) increase the number of patients who start cardiac rehabilitation and (b) counsel patients longer and better in developing and maintaining a healthy lifestyle (Inspectie voor Volksgezondheid, 2013).
The Hearts4People foundation and Leiden University have developed a new theory-based method for cardiac rehabilitation, the ‘CardioVitaal’ programme. This programme is a blended form of cardiac rehabilitation, in which patients work towards complete self-management in three phases. The first phase revolves around ‘Self-confidence’: rebuilding confidence in one’s body and gaining confidence in behavioural change. The focus of the second phase is on 'Self-regulation': aligning health targets with important life goals, taking action and monitoring health behaviour in different situations (home and in hospital/rehabilitation centre). The third and final phase is the ‘Self-management' phase: patients work towards full management of their heart condition and maintaining the new lifestyle while at home. Reward is an important part of sticking to the new regime: every step that a patient takes to affirm healthy behaviour is rewarded with loyalty points, which can be exchanged for discounts or goods.
The principle is that face-to-face counselling in the rehabilitation centre is gradually replaced by online counselling via a personal digital platform. This platform enables people to monitor and improve their lifestyle and main risk factors. The advanced lifestyle loyalty programme persuades people to stay active and committed.
In this project, this approach is multicentre implemented and evaluated. Both project leaders (V. Janssen en R. Kraaijenhagen) are closely involved in national developments and single and multidisciplinary initiatives within cardiac rehabilitation, such as the Landelijk Multidisciplinair Overleg Hartrevalidatie, the Commissie Cardiovasculaire Preventie en Hartrevalidatie (Nederlandse Vereniging voor Cardiologie),the Landelijke Werkgroep CardioPsychologie (Nederlands Instituut van Psychologen) and Stichting CARDSS.