Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease.

ABSTRACT

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale-modified (HADS-M) version. Spearman's rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit) age (OR = 0.98, 95% CI 0.95-0.99), educational level (OR = 1.45, 95% CI 1.05-2.02), financial status (OR = 0.43, 95% CI 0.21-0.83), medication irregularity (OR = 0.25, 95% CI 0.07-0.72), presence of comorbidities (OR = 6.18, 95% CI 1.83-23.78), health care services provided by a nurse (OR = 1.25, 95% CI 1.03-1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI 1.02-1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI 1.09-1.44), psychological (OR = 1.68, 95% CI 1.25-2.37), and physical (OR = 1.24, 95% CI 1.05-1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.