“The physician should look upon the patient as a besieged city and try to rescue him with every means that art and science place at his command.” — Alexander of Tralles
Among the most difficult challenges for CV professionals is working with patients who sincerely believe that they are taking better care of themselves than they actually are. Clearly it is difficult to rescue a “besieged city” that does not realize it is under capture.
In order to understand and compare patient attitudes with those of clinicians, the ACC conducted two online studies — one among 1,315 patients diagnosed with heart disease and the other with cardiovascular professionals — 547 U.S. cardiologists and 129 care team practitioners.
Heart patients rate themselves favorably on self-care. Three out of four cardiovascular patients believe that they are doing what they need to do for their health while only 24% of clinicians rate patients positively on self-care. This contrast is possibly a function of denial or self-inflation. According to one patient, “I would give myself a 3 (on a 1–5 scale) and I know my cardiologist would give me a 2. My numbers are good, but every time I go I just lose enough weight so he won’t yell at me.”
For the most part, clinicians and patients are in agreement on the challenges to self-care. According to clinicians, the three biggest challenges to patient care are the inability to lose weight (92%), medication adherence (90%), and exercise (87%). Other patient challenges also cited by clinicians include diet, smoking cessation, other co-morbidities, poor insurance coverage/access to care and lack of motivation. Similarly, patients name exercise (64%), diet (52%), and weight loss (51%) among their top struggles. Other barriers to self-care include medication costs, complexity of treatment, side effects and insurance coverage.
“Many times patients come in and their blood pressure isn’t controlled and they swear they have been taking their medication,” reports one cardiologist. “I am sure they are forgetting some. They are not as compliant as they should be.” While health care professionals express frustration about medication adherence, almost all patients (89%) say they are extremely diligent about taking their prescribed medication.
While half (49%) of the patients who participated in this research rate their health as good or excellent, three-fourths (74%) are very concerned about their health. When asked what type of patients are most in need of self-care information, more than four-in-five clinicians (85%) respond “all patients.” However, they do acknowledge that some audiences could use additional support, specifically those who suffer from more acute heart disease conditions (i.e. heart failure, cardiomyopathy) and co-morbid conditions (i.e. diabetes, COPD).
Clinicians also advocate for materials targeted specifically to African Americans. According to the patient research, these groups also seem to be in more need for patient self-care resources than other patient groups. A lack of information does not seem to be the problem as almost all clinicians report that their practice has a variety of tools and resources to inform and educate patients and families ranging from the more popular printed education materials such as brochures, pamphlets, and other printed material to the somewhat less utilized 3-dimensional visual aid models, practice websites, patient/family handbooks, risk calculators, desktop computers, live events and TV with video. Decision aids or shared decision tools and portable handheld tablets are used less often. Almost all patients (84%) report that they have received information and resources from their physician’s practice.
The challenge seems to be in providing the right type of information, education, and of course, motivation. When asked if a need exists for a patient education resource that is developed by cardiologists and other cardiovascular specialists for their patients, clinicians respond with a resounding “YES”. Nearly all clinicians (97%) indicate a need for patient education developed by CV professionals and most (77%) of this sentiment is strong.
Cardiologists are well-poised to deliver this type of care information to their patients. They receive good marks from their patients with two-thirds (65%) rating the physician treating their heart disease as “excellent.” Patients favorably describe their cardiologists as knowledgeable (92%), treats me with courtesy and respect (91%), and having credentials/expertise in their field (88%). Cardiologists also receive good marks from patients on explaining things in a way that is easy to understand (85%), involving the patient in the decision process (83%), providing easy to understand instructions (82%), and caring about the patient (81%).
While clinicians are interested in materials developed by CV professionals, more than four out of five patients (82%) are looking for information that can help them manage expectations and concerns, namely – information about what to expect over time (58%), what is normal/not normal for a condition (57%), benefits and risks of various treatments (47%), “my responsibilities” (30%), explanatory videos (20%), condition-focused information (18%), expert commentary (16%), medication reminders (14%), and peer-to-peer support resources (13%) among others.
“I think there needs to be more education. It would help if they handed you a pamphlet ...these are the symptoms, this is what kind of things you should be expecting, this is how to deal with it, and this is what your body is going through.” — Cardiovascular patient