Abstract
Users with cardiovascular pathology go through the different levels of the health system, with brief interactions with various health professionals, so it is necessary to consider their perspectives and experiences, focusing on accessibility, service provision, discharge and referral (1).
Within the scope of the Cardiac Integrated Care project, this study aims to explore the user's health journey after acute myocardial infarction (AMI), focusing on their interactions with the Portuguese healthcare system, identifying barriers, facilitators, experiences, outcomes for individuals and /or their caregivers and family members as they enter, navigate, experience, and exit the healthcare system (2).
For the study, users diagnosed with AMI and discharged from the Cardiology Department of ULS Coimbra, between January and December 2023, were considered eligible (n=76). Once the inclusion criteria were applied (not deceased, telephone number available), semi-structured telephone interviews were carried out after obtaining verbal informed consent. The interviews were carried out in age order (youngest first) until data saturation.
A collaborative data analysis (3) was carried out by a multidisciplinary group involving nurses from cardiology and primary health care, cardiologists, general practitioners, hospital and community pharmacists and users who had AMI.
Of the 19 interviews carried out, data on establishing goals with the user, explanation of the therapeutic scheme, perception of the quality of the service, quality of discharge, as well as follow-up (1st consultation after discharge and follow-up in primary health care) were categorized.
Data analysis revealed variability in the health journey of users after AMI, particularly in the first contact with health services after discharge and in follow-up by primary health care (medical and nursing consultations). Regarding satisfaction, from the user's perspective, a high level was observed in the quality of discharge and in the service provided during hospitalization, but a less satisfactory level in the follow-up.
This study highlights the importance of a user-centered approach that takes into account users' expectations and needs along the health journey after an AMI. The information resulting from the analysis of the user's trajectory can guide the co-creation of solutions that improve the quality, results and satisfaction of the care offered, addressing emerging challenges in the Portuguese healthcare system.
1.Ski C, Cartledge S, Foldager D, Thompson D, Fredericks S, Ekman I, et al. Integrated care in cardiovascular disease: a statement of the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. Eur J Cardiovasc Nurs. 2023;zvad009. https://doi.org/10.1093/eurjcn/zvad009.
2.Bulto L, Davies E, Kelly J, Hendriks J. Patient journey mapping: emerging methods for understanding and improving patient experiences of health systems and services. Eur J Cardiovasc Nurs. 2024;zvae012. https://doi.org/10.1093/eurjcn/zvae012.
3.Cornish F, Gillespie A, Zittoun T. Collaborative Analysis of Qualitative Data. The SAGE Handbook of Qualitative Data Analysis. 2014, London: SAGE Publications, 2014, 79–93. https://sk.sagepub.com/reference/the-sage-handbook-of-qualitative-data-analysis/i633.xml