Situational analysis of self-management and continuing care for patients after coronary artery bypass graft surgery: From tertiary care to primary care and community networks

Abstract

This qualitative descriptive study aimed to examine the current situation of home-based self- management of, and continuing care for, patients after Coronary Artery Bypass Graft (CABG), who were discharged from tertiary care institutions to their homes, communities, and primary care networks. Data were collected from 48 participants in four groups: patients, primary caregivers, community health volunteers, and other personnel. Data collection was carried out from July 2019 to November 2020 by in-depth interviews, observations, patients’records and related documentations. The content analysis approach was used for data analysis, with CREER’s 6 steps of Self-Management of Chronic Illness (2000).

The results showed that (1) The patients’ and the main caregivers’ perspectives: they had high satisfaction with post-surgery care from tertiary care settings. However, they needed more preparation on specific knowledge and skills for self-management at home, referral for continuing care, and appropriate support from local primary healthcare provider teams, such as home visits. (2) Healthcare providers’ viewpoint: they expressed that there were limitations in referral of information and patients’ data from tertiary care facilities to primary care settings. In addition, they suggested that training to improve knowledge and skills or providers should be implemented in order to promote confidence in caring for post-CABG patients continually and fulfill patients’ needs comprehensively. Clinical practice guidelines in caring for post-CABG patients according to CREER model should be developed to improve continuing care systems. The CPG should include self-management of patients, development of referral system after surgery from tertiary care to primary care and community settings. This will enable nurses and multidisciplinary team to take care of patients more comprehensively.