Bridging the transition from hospital-to-home: Effects of the vital telehealth program on recovery in coronary artery bypass graft surgery patients and their caregivers.

摘要

This randomized controlled trial determined whether the delivery of a telehealth program after discharge from hospital for coronary artery bypass graft (CABG) surgery made a difference in the post-surgical adjustment and health service use of patients and caregivers. Patients and caregivers (n=182) consented to be randomly assigned to receive one week of daily home audio-video visits from a nurse or routine cardiac instruction only in-hospital. Participants completed individual telephone interviews the day before surgery and 5 days and 3 weeks after discharge.;Data were analyzed using 2x2 analyses of covariance assessing the main effects of telehealth and patient sex and their interaction on changes in the dependent variables, including baseline scores as covariates. Results showed no difference between changes in anxiety for patients in telehealth versus usual care. However, patients in telehealth showed greater decreases in perceived uncertainty (p=.03) and increases in perceptions of treatment control (p=.09) than the comparison group. Also, fewer telehealth patients contacted their physicians (p=.04). For caregivers of male patients in telehealth there was a greater change in anxiety than for caregivers of male patients in usual care (p=.0003). While greater decreases in uncertainty (p=.002) and increases in perceived personal control (p=.10) were also realized for caregivers of male patients, greater reductions in depression symptoms (p=.03) and perceptions of conflict (p=.04) were experienced by caregivers in telehealth compared to usual care, regardless of the sex of the caregiver The coping styles of neither patients nor caregivers influenced their responses to telehealth. Finally, changes in caregivers of male patients' uncertainty were associated with reductions in anxiety, and accounted for more than one third of the observed changes in anxiety. These results can help guide the recruitment of patients into telehealth with knowledge that male and female CABG surgery patients and caregivers can benefit from the service, though in different ways. Future research that examines caregiver and patient outcomes needs to include enough participants of both sexes in order to achieve adequate power to detect clinically meaningful results for women and men.;The primary outcomes were changes in anxiety between entry into the program and 3 weeks after discharge for patients and caregivers. Exploratory outcomes included changes in participants' depression symptoms, perceived uncertainty, illness control, support, and conflict with the caregiver, as well as use of health services over the same time period. The potential moderating effects of sex and coping style were also explored.