Supportive Psychotherapy for Healthcare Professionals in The Management of Acute Coronary Syndrome: The Use of Delphi Technique.

BACKGROUND: Supportive psychotherapy (SP) may increase the benefit of acute coronary syndrome (ACS) management, but there is no structured SP as a guideline for healthcare professionals. This study aimed to develop structured SP as a guideline for implementing psychotherapy in the management of ACS patients in intensive cardiac care unit (ICCU). METHODS:  This qualitative study used Delphi technique as a modified Delphi method to reach a consensus among experts of structured SP for healthcare professionals in the management of ACS during hospitalized in ICCU. This was developed using self-reflection, observation, and interview of SP implementation in daily psychosomatic practice, gathering literature reviews, doing focus group discussion (FGD) and interview with ACS survivors. During the Delphi rounds, we interviewed 50 informants as source people using valid questionnaires, to proceed a draft of the SP framework and the structured sessions. The SP framework draft and the structured sessions were evaluated and corrected by experts anonymously until the consensus was reached. The validity of the consensus was tested, using Likert psychometric scale to reach an agreement. Cronbach alpha test was used to assess construct validity with SPSS 20. RESULTS:  All of preparations conducted before the Delphi rounds showed that ACS patients had psychosomatic disorders during in ICCU, that required support. SP is very helpful to reduce the negative impact of this disorders.Off 50 informants answered a valid and reliable questionnaire which supports the above statement. The draft was made based on the above process. The development of SP for healthcare professionals of ACS managements was reached in a consensus of expert panelists in the second round of the Delphi with Cronbach alpha of 0.9. CONCLUSION: Supportive psychotherapy (SP) for healthcare professionals in the management of ACS in ICCU were developed and may be applied in clinical practice and research.

Usefulness of the CODE ST-Segment Elevation Myocardial Infarction Program to Improve Quality Assurance in Patients With ST-Segment Elevation Myocardial Infarction.

The highest mortality rate associated with acute coronary syndrome is observed in patients with ST-segment elevation myocardial infarction (STEMI). Quality care in STEMI management depends on timely reperfusion of the ischemic coronary artery. The CODE STEMI program has been developed to reduce delays and serves as a method to improve quality care in patients with STEMI. Our study aimed to investigate the effects of implementing the CODE STEMI program on quality care and hospital marketing strategy. Our research was a descriptive study with mixed evaluation methods. We enrolled 207 patients with STEMI who underwent primary percutaneous coronary intervention from 2015 to 2018. We used quantitative methods by tracking medical records and administrative documents, as well as qualitative methods by observation and in-depth interviews. Statistical analysis was done using Mann-Whitney and chi-square tests. Our study demonstrated reduced door-to-balloon time, total cost, and length of stay of patients with STEMI who were treated with the CODE STEMI program (p <0.001, p <0.001, and p = 0.009, respectively). In addition, there was a likely decrease in major adverse cardiac event incidence and mortality rate after the implementation of CODE STEMI. The hospital and patients expressed their satisfaction with the CODE STEMI program. The program proved to have good efficacy, effectiveness, optimality, acceptability, legitimation, and equity. It also met the marketing mix principles, which included increasing the total number of patients with cardiovascular diseases as well as increasing levels of public trust in STEMI management. In conclusion, the CODE STEMI program has a positive impact on quality care and hospital marketing strategy.

Validity and Reliability of the Indonesian Version of SF-36 Quality of Life Questionnaire on Patients with Permanent Pacemakers.

AIM: to construct and validate Indonesian version of SF-36. METHODS: this is a cross-sectional study, which consist of 2 stages process: 1) language and cultural adaption; and 2) validity and reliability evaluation. We evaluated 32 pacemaker patients during language and cultural adaptation stage and 20 pacemaker patients during validity and reliability evaluation stages from September 2014 to August 2015. We followed cross-cultural adaptation guideline to produce Indonesian version of the questionnaire. The final translated questionnaire was checked by assessing the correlation of SF-36 and 6-minutes walking test (6MWT) and NT pro-BNP result. RESULTS: Indonesian version of SF-36 showed positive correlation between 6MWT result and physical functioning (PF) (r=0.363; p=0.001) and negative correlation between NT pro-BNP score with general health (GH) (r=-0.269; p=0.020) and mental health (MH) (r=-0.271; p=0.019). The internal consistency of Indonesian version of SF-36 questionnaire, which measured by Cronbach's alpha, was good with value of >0.70. Repeatability between day 1 and day 8 was good, with strong positive correlation (r=0.626; p=0.003). CONCLUSION: the Indonesian version of SF-36 could be used as a general questionnaire to assess quality of life in patients with permanent pacemaker.