Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts
Introduction
The rate of coronary artery bypass surgery (CABG) has been declining in the USA [1], while increasing in low middle-income countries like Iran with an annual open heart surgery rate of 25,000, including approximately 60% CABGs [2]. However, the exact statistics for the burden of this disease still is not available in Iran [3]. Therefore, in order to avoid complications, it remains important for the healthcare system to try to promote a high quality of life in patients with heart disease [4].
Today’s length of hospitalization has declined worldwide after all surgeries, including CABG, and patients undergoing this considerable surgery are discharged at only 3–8 days following surgery [5]. Consequently, the majority of the healing and recovery processes, such as the healing of surgical wounds and rehabilitation of cardiac function, are now done at home or other facilities outside the hospital [6].
After heart surgery, both patients and their family often have concerns and educational needs, and many have concerns about the resulting quality of life after discharge [7], [8]. The patients and their family are responsible for their total care at home [9], [10], but many problems can occur due to a lack of appropriate knowledge and skills in self-care. These problems increase with inadequate patient education, counseling and follow-up with therapeutic care [11].
Financial and human resources limitations have increased the need for newer, practical and cost-saving approaches [12], [13], [14], [15], and anticipating the costs for planning therapeutics and health services is necessary, according to budget restrictions and prioritization [16], [17].
Nowadays, the quality of healthcare has noticeably improved with the use of tele-health [18], which is defined as the process of educating, consulting and following-up care and therapy plans from a distance using telecommunications technology, including telephone and Internet (voice and video conferencing). Tele-health allows care providers to provide various services, including training, monitoring, data collection, care control and patient and family support, regardless of time and location restrictions [19], [20].
Tele-health could be used more appropriately in low and middle-income countries, such as Iran, while adapting it to local limitations; for example, the low Internet use index when compared to the use of the telephone and cell phone [21], [22]. Studies have shown that patients are satisfied and willing to receive healthcare services, treatment, care, patient education and counseling via the telephone [23].
Tele-health can also improve a patient’s quality of life by strengthening and sustaining education about their care, treatment and counseling, and supporting the relationship between the care providers and their patients while providing access to vital information among the patients, their families and the healthcare providers [24]. Moreover, tele-health can save time to patients and their families by decreasing the need for their physical presence in healthcare centres [25].
Tele-health centres can provide therapy and care delivery in low and middle-income countries. However, in Iran, tele-health system is almost non-existent, due to the myth that the presence of an actual healthcare centre would provide much better patient education and counseling [7]. The national healthcare system in Iran seeks more cost-effective and accessible healthcare methods for clients, considering the growth in the cost and vital role of long-term follow-up care after major surgeries like CABG [26]. The aim of this study was to assess the effects of telephone counseling on the quality of life of patients discharged after receiving CABG.
Section snippets
Methods
A quasi-experimental study was conducted using conventional sampling of 76 patients discharged after CABG from the Ekbatan educational hospital in Hamadan, Iran, in 2014. The overall study process was approved by the Research Ethics Committee of Hamadan University of Medical Sciences. Patients who had undergone CABG were included if they met the following criteria in terms of the absence of: (a) chronic respiratory disease; (b) addiction to alcohol or narcotic substances; and (c) history of any
Results
Overall, 75% of the patients in the intervention group and 62.9% of those in the control group were male. In the intervention and control groups, the mean ages were 62 ± 7.41 and 64.03 ± 7.77, respectively, and 38.9% and 54.3% were low literacy level or uneducated, respectively. The percentages of the patients living in urban areas in the intervention and control groups were 75% and 70.6%, respectively, and their households ranged between 2 and 4 people in 36.1% and 48.6% of the cases, respectively
Discussion
Considering the growth in the number of patients with heart disease and increase in CABG procedures, it is crucial to assess how the lives of these patients and their families are affected by the surgery, that is, the quality of life. In this study, most of the patients were male, which is in line with Miracle's study results about the higher incidence of cardiovascular disease in men [33]. Moreover, the age of the patients in this research was between 42 and 76 years, reinforcing the fact that
Conclusions
Telephone counseling for patient education and counseling promotes a higher quality of life in CABG patients after discharge due to improvements in the physical, emotional and social domains and the timely access to information and educational care. Therefore, especially in low middle-income countries such as Iran with a large urban population and increase in CABG being performed, the units or agencies in educational hospitals or healthcare centres should consider providing nurses and telephone
Practice implications
Interest in cost-effective plans by using new technologies such as cell phone, tablet, and internet has increased in health care service delivery.
Telephone counseling is feasible to implement, well accepted for patient education and counseling. Simplification of patient education and counseling in this approach has achieved by reducing formalities, displaying in a positive direction, using non-technical language and evaluative elements. This approach offer considerable potential to reduce
Funding
This work was funded by Research Council of Hamadan University of Medical Sciences, Hamadan, Iran (approval No: 920210420, dated 23.12.2013).
Authors' contributions
AB contributed to the conception and design of this study, took responsibility for and coordinated the acquisition of the data, and took part in the write-up and finalization of the manuscript. BM contributed to the conception and design of this study, gathered and analysed the data, took an active part in the analysis of the data, and contributed to the abstraction and write-up of the manuscript. MG and GR were involved in the data collection process, and took part in the data analysis and
Conflict of interest
The authors declare that there are no conflicts of interest with regard to this research.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Acknowledgments
Our special thanks and appreciation go out to all of the staff members of the intensive care units of Ekbatan's educational hospital at the Hamadan University of Medical Sciences, and the patients and their families who assisted the researchers in conducting this study. We would also like to thank all of the officials involved in the approval process.
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