Inequality in continuity of care after hospitalization due to cardiac conditions

Abstract

Background Cardiac conditions are a common cause of hospitalization worldwide. The need for follow-up within primary care and/or specialized care continues after discharge. Continuity of care is crucial to enable a seamless chain of care after hospitalization. Research regarding inequality in continuity of care after discharge is lacking. Purpose The aim was to investigate how patients’ perceptions of continuity of care vary between age, gender, and diagnosis groups. Methods Patients were consecutively included within six weeks after hospitalization due to a cardiac condition. Data were collected with the short version of the Patient Continuity of Care Questionnaire (PCCQ-12). The independent t-test was used to compare differences between sexes and age groups (< 65 years or ≥ 65 years). Differences between diagnosis groups were evaluated with the one-way analysis of variance (ANOVA) and post-hoc analysis with the least significant difference (LSD) correction. The significance level was set at p <0.05 for all analyses. Results A total of 1,000 patients were included (mean age 72 years (SD 10) 66% male). The patients were hospitalized due to myocardial infarction (36%), atrial fibrillation (26%), angina pectoris (21%) or heart failure (17%). Significant differences between age, gender and diagnosis were found: Patients < 65 years perceived significantly higher levels of continuity of care than patients ≥ 65 years. Men had significantly higher scores than women. Patients hospitalized due to acute myocardial infarction perceived significantly higher levels of continuity of care compared to patients who had been hospitalized due to angina pectoris, atrial fibrillation, or heart failure (Table 1). Significant differences were also found between men and women. Men <65 years perceived significantly higher levels of continuity of care (mean 48.08) compared to men ≥ 65 years (mean 45.51, p= 0.008 ). Men who had been hospitalized due to myocardial infarction had significantly higher scores on the PCCQ-12 (mean 48.82) compared to men who had been hospitalized due to angina (mean 44.48), atrial fibrillation (mean 44.09) and heart failure (mean 45.24) (Figure 1). Women <65 years had significantly higher scores on the PCCQ-12 (mean 45.00) compared to women ≥ 65 years (mean 40.71, p 0.018). Women who had been hospitalized due to myocardial infarction or atrial fibrillation had significantly higher scores on the PCCQ-12 (mean 42.48 and 43.02, respectively) compared to women hospitalized due to heart failure (mean 38.00) (Figure 1). Conclusion Overall, patients hospitalized due to cardiac conditions perceive a rather high level of continuity of care. However, statistically significant differences were found between men and women, between younger and older patients, and between diagnosis groups, indicating that care inequality exists in continuity of care.