title: Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants.
  
  
  METHODS
  199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure.
  
  
  RESULTS
  In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097).
  
  
  CONCLUSIONS
  A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes.
  
  
  BACKGROUND
  Swedish registry, Researchweb.org, ID NR 65 791.
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden. Electronic address: andreas.fors@gu.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fors
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: http://www.gpcc.gu.se.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gyllensten
authors.affiliation: Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address: http://www.gpcc.gu.se.
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. Electronic address: http://www.gpcc.gu.se.
authors.forename: Inger
authors.initials: I
authors.lastname: Ekman
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D000359:Aftercare / Q000379:methods*; D000368:Aged; D059026:Diagnostic Self Evaluation; D004522:Educational Status; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D018802:Patient-Centered Care / Q000379:methods*; D011788:Quality of Life; D013548:Sweden
keywords: Cardiac rehabilitation; Myocardial infarction; Patient-centered care; Person-centred care; Randomized controlled trial; Socioeconomic factors