title: Barriers to effective self-management in cardiac patients: the patient's experience.
abstract: OBJECTIVE
  This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients' efforts to care for their illnesses.
  
  
  METHODS
  We convened 33 focus group discussions with heart patients in 10 U.S. communities. Using content analysis, we identified and grouped the most common barriers that emerged in focus group discussions.
  
  
  RESULTS
  We identified nine major themes reflecting issues related to patients' ability to care for and manage their heart conditions. We grouped the themes into three domains of interest: (1) barriers that interfere with getting necessary services, (2) barriers that impede the monitoring and management of a heart condition on a daily basis, and (3) supports that enable self-management and improve care.
  
  
  CONCLUSIONS
  For disadvantaged populations, typical problems associated with self-management of a heart condition are aggravated by substantial obstacles to accessing care.
  
  
  CONCLUSIONS
  Ensuring disadvantaged patients with chronic heart conditions are linked to formal systems of care, such as cardiac rehabilitation programs, could better develop patients' self-management skills, reduce barriers to receiving care and improve the overall health outcomes of these patients.
authors.affiliation: The George Washington University School of Public Health and Health Services, Department of Health Policy, Washington, DC 20006, USA. khmead@gwu.edu
authors.forename: Holly
authors.initials: H
authors.lastname: Mead
authors.forename: Ellie
authors.initials: E
authors.lastname: Andres
authors.forename: Christal
authors.initials: C
authors.lastname: Ramos
authors.forename: Bruce
authors.initials: B
authors.lastname: Siegel
authors.forename: Marsha
authors.initials: M
authors.lastname: Regenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003266:Continuity of Patient Care; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D017060:Patient Satisfaction; D012648:Self Care; D012944:Social Support; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult