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- Blanck, Elin
(författare)
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Att mötas utan att ses - om partnerskap och personcentrerad vård på distans
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate and describe person-centred care over the telephone to people with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) and to elucidate informal carers’ experiences of support. The methods used in this thesis were related to the specific aims of the included studies. Study I was a randomised controlled trial that evaluated the effects of person-centred care delivered over the telephone to people with COPD or CHF. The evaluation showed that person-centred support over the telephone could mitigate the worsening of self-efficacy without increasing the risk of adverse events for this patient group. Study II aimed to contribute to future empirical analyses of partnership by outlining the social, moral, and cognitive forms of accountability to explore how participants engage in negotiating and establishing partnership in a person-centred care context. Study III was a phenomenological hermeneutical study to elucidate the meaning of the support given and received by informal carers of relatives with COPD or CHF. The meaning of support for these carers is twofold: it is a self-evident strive for the good life of their relatives, and it is a wish to be included as carers in partnership in interactions with healthcare providers. Study IV aimed to explore associations between self-efficacy, and health care and drug expenditure (i.e. direct costs) in patients with COPD or CHF using longitudinal statistical methods. The findings indicate that increased or sustained self-efficacy is associated with lower direct costs. The conclusion of this thesis is that remote person-centred care could, through the jointly achieved process of partnership, mitigate worsening self-efficacy in patients with COPD and CHF. Partnership may also be understood as cooperation between informal carers and their relatives and a wish among carers to be included and recognised by the healthcare system. This thesis is written in Swedish and includes a summary in English.
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- Blanck, Elin, et al.
(författare)
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Self‐efficacy and healthcare costs in patients with chronic heart failure or chronic obstructive pulmonary disease
- 2023
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Ingår i: ESC Heart Failure. - 2055-5822.
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Aims This study aims to explore possible associations between self‐efficacy and healthcare and drug expenditures (i.e. direct costs) in patients with chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) in a study investigating the effects of person‐centred care delivered by telephone. Methods and results This exploratory analysis uses data from an open randomized controlled trial conducted between January 2015 and November 2016, providing remote person‐centred care by phone to patients with CHF, COPD, or both. Patients hospitalized due to worsening of CHF or COPD were eligible for the study. Randomization was based on a computer‐generated list, stratified for age ≥ 75 and diagnosis. At a 6 month follow‐up, 118 persons remained in a control group and 103 in an intervention group. The intervention group received person‐centred care by phone as an addition to usual care. Trial data were linked to register data on healthcare and drug use. Group‐based trajectory modelling was applied to identify trajectories for general self‐efficacy and direct costs. Next, associations between self‐efficacy trajectories and costs were assessed using regression analysis. Five trajectories were identified for general self‐efficacy, of which three indicated different levels of increasing or stable self‐efficacy, while two showed a decrease over time in self‐efficacy. Three trajectories were identified for costs, indicating a gradient from lower to higher accumulated costs. Increasing or stable self‐efficacy was associated with lower direct costs ( P = 0.0013). Conclusions The findings show that an increased or sustained self‐efficacy is associated with lower direct costs in patients with CHF or COPD. Person‐centred phone contacts used as an add‐on to usual care could result in lower direct costs for those with stable or increasing self‐efficacy.
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