Question

Part 1

Read the scenario.

Patients who have scheduled coronary artery bypass grafts have a great need for education before, during, immediately following, and after discharge. This education helps the patient understand the procedure and what they should expect. It is essential to provide information regarding care before, during, and after the surgery. Also, patients need information on pain management, resuming activity and physical therapy, self-care, limitations, and concerns that they should report.

Part 2

Post a response to the discussion board.

Discuss the following questions in your post:

How can informatics be used to improve a patient's education about a CABG?

How can educating patients through informatics improve patient outcomes?

Describe at least two of the ten levels that e-patients access and use in regards to health care information online.

If a patient who is scheduled for a CABG states "I know all about this. I have been reading up on the Internet"—what concerns do you have?

What types of sources would you suggest a patient seek on the Internet?

Answer 1

Introduction: Secondary prevention after CABG improves morbidity and mortality, yet adherence remains poor. The inpatient stay for CABG is an invaluable teachable moment, and so it is imperative that the education we provide motivates adherence. There is limited data about whether patients identify their medications as preventive, or if this knowledge affects adherence behavior.

Hypothesis: To determine if patient understanding of medication purpose and patient perception of medication importance affects adherence behavior.

Methods: This was a prospective cohort study to evaluate medication adherence after discharge from CABG and CABG plus valve procedures at Wake Forest Baptist Hospital. A total of 49 patients met inclusion criteria and were enrolled. Participants were approached after receiving standardized nursing education before discharge and completed surveys addressing patient understanding of medication purpose and importance. Three months after discharge patients were contacted by phone and read the Morisky Medication Adherence Scale (MMAS-8), with a follow-up rate of 94%.

Results: Only 27% of patients identified their cardiac medication regimen as lifelong and to promote future heart health. Most patients correctly identified the pharmacologic purpose of all 4 medications (aspirin, beta-blocker, ACEI, and statin). Significantly, 60% of patients with high adherence as defined by the MMAS-8 at 3 months had originally identified that daily use of their medications was important to maintaining long term health, while only 12% of those with low or medium adherence behaviors had identified the same (p = 0.000509).

Conclusions: Patients appear to understand the mechanisms of action of cardiac medication but generally don’t appreciate their long-term preventative value. As such, patients may believe that they can discontinue the medications when objective criteria are met, such as lowered blood pressure, thus missing the potential benefit of decreased cardiac events and mortality.