Do Depressive Symptoms Moderate the Effects of Exercise Self-efficacy on Physical Activity Among Patients With Coronary Heart Disease?

BACKGROUND: Exercise self-efficacy is an important predictor of physical activity. Patients with coronary heart disease are at risk of developing depressive symptoms that could further weaken their self-efficacy and interfere with their ability to engage in physical activity. OBJECTIVE: The aim of this study was to examine the relationship between depressive symptoms, exercise self-efficacy, and physical activity among patients with coronary heart disease and how the efficacy-activity relationship is affected by the patient's level of depression. METHODS: A survey was conducted on 149 participants at the time of discharge from the emergency and in-patient medical wards at 2 regional hospitals. RESULTS: The sample was mostly male, married, living with families, and of lower socioeconomic status. The mean exercise self-efficacy was 4.26 ± 2.73, and the median physical activity was 12 (interquartile range, 6-21). Approximately 26% of participants had high depressive symptoms. Those with more depressive symptoms reported lower self-efficacy scores and lower physical activity. In multivariate regressions, self-efficacy was an independent predictor of physical activity (b = 1.48, P < .001). After including depressive symptoms as the interaction term, exercise self-efficacy had a significantly stronger and positive relationship with physical activity (b = 0.14, P = .043). CONCLUSION: Exercise self-efficacy had a positive association with physical activity, and this relationship was stronger among coronary heart disease patients with depressive symptoms. This finding suggests that self-efficacy might be important in encouraging individuals with depressive symptoms to participate in physical activity. More efforts should target the development of effective strategies to improve exercise self-efficacy as a way of promoting physical activity among depressed coronary heart disease patients.

Factors and post-discharge outcomes associated with patients' readiness for discharge from the emergency medicine ward: A prospective study.

BACKGROUND: Discharging patients with a self-reported low readiness for hospital discharge (RHD) may be challenging, as these patients may be vulnerable to risks and adaptation issues that can delay recovery. However, little is known about whether emergency medicine ward (EMW) patients are sufficiently prepared for discharge to home. Therefore, the aim of this study is to examine the factors and outcomes associated with patients' RHD in an EMW setting. METHODS: One hundred and eighty-four patients were recruited from the EMW of a tertiary hospital in Hong Kong. Cross-sectional data were collected from self-administered questionnaires and patients' medical records at the time of discharge and 1 month later. Descriptive statistics were obtained, and the variables were subjected to multivariable regression analyses. RESULTS: Seventy-three patients (40%) reported a low RHD at the time of discharge. Living with someone was a factor contributing to a patient's perceived RHD. A greater RHD was associated with a lower risk of 30-day emergency department readmission (odds ratio [OR] = 0.75; 95% confidence interval [CI] = 0.57-0.99) and hospital readmission (OR = 0.59; 95% CI = 0.38-0.91). However, patients who reported higher scores on the knowledge RHD subscale had a higher risk of hospital readmission (OR = 2.34; 95% CI = 1.38-3.98). CONCLUSION: These findings demonstrate the importance of paying careful attention to social support network of patients and the provision of patient education, as these may improve patients' RHD prior to discharge from the EMW. (242 words).

Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study.

OBJECTIVES: To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. BACKGROUND: Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. METHODS: A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. RESULTS: No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. CONCLUSION: The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department.

Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments.

OBJECTIVE: This study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. METHODS: This study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. RESULTS: During the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27 days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13 days from the previous length of 5.16 days. CONCLUSIONS: EMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.