The Effect of Education Based on the Chronic Care Model (StrokeCARE) in Patients With Ischemic Stroke
Condition: Stroke, Ischemic; Self Efficacy
MeSH terms: Stroke; Ischemic Stroke; Ischemia
Study type: Interventional

Summary: 
      -  Stroke is the third leading cause of death worldwide and is defined as neurological
           deficit due to ischemic or hemorrhagic causes. The risk of death in the 30 days
           following recurrent stroke was reported to be between 23% and 41%, and the risk of new
           disability was between 39% and 53%. Therefore, patient self-management is important in
           preventing recurrent stroke. The aim of this study was to evaluate the effect of
           education and telephone follow-up based on the Chronic Care Model on self-management,
           quality of life and patient satisfaction in patients with ischemic stroke. The study is
           a randomized controlled experimental study. A total of 68 patients (34 interventions and
           34 controls) were randomized into a computer program with 80% power, 95% reliability and
           0.05 margin of error. Patients were included in the study according to the inclusion
           criteria and randomization list. The self-management support component of the Chronic
           Care Model was implemented using the 5A (ASK, ADVICE, ASSESS, ASSIST, ARRANGE)
           methodology. The Conceptual-Theoretical-Experimental structure of the research was
           created. A training booklet for stroke patients was created within the scope of the
           Chronic Care Model self-management support component. After the pre-tests, the patients
           who were included in the intervention group were given discharge training with a booklet
           prepared based on the Chronic Care Model and containing information and recommendations
           on self-management strategies during their stay in the hospital (0 months). These
           patients were followed up by telephone on the 7th day, 15th day, 1st month and 2nd month
           after discharge. No intervention other than routine hospital follow-up was performed for
           the patients included in the control group.

        -  The patients who were included in the control and intervention groups were performed to
           post-tests at the 3rd month outpatient clinic control and metabolic variables of the
           patients were obtained from the patient clinical information system.
    

Detailed description: 
      Stroke is the third leading cause of death worldwide and is defined as neurological deficit
      due to ischemic or hemorrhagic causes. Stroke is an important health problem in Turkey as it
      is common in society and causes death. Stroke patients are reported to be at risk for
      secondary stroke. The risk of death in the 30 days following recurrent stroke was reported to
      be between 23% and 41%, and the risk of new disability was between 39% and 53%. Therefore,
      patient self-management is important in preventing recurrent stroke. One of the most widely
      accepted and effective models in the international literature for chronic diseases is the
      Chronic Care Model. The aim of this study was to evaluate the effect of education and
      telephone follow-up based on the Chronic Care Model on self-management, quality of life and
      patient satisfaction in patients with ischemic stroke.

      The study is a randomized controlled experimental study. The sample of the study included
      inpatients with stroke in Akdeniz University Hospital Neurology Clinic. A total of 68
      patients (34 interventions and 34 controls) were randomized into a computer program with 80%
      power, 95% reliability and 0.05 margin of error.

      In this study, four components of the Chronic Care Model were applied. These elements are
      self-management support, delivery system design, decision support and clinical information
      systems. The self-management support component of the Chronic Care Model was implemented
      using the 5A (ASK, ADVICE, ASSESS, ASSIST, ARRANGE) methodology. The
      Conceptual-Theoretical-Experimental structure of the research was created.

      According to the intervention protocol of the study:

        -  A training booklet for Stroke Patients was created within the scope of the Chronic Care
           Model self-management support component. The quality of the booklet was evaluated by the
           DISCERN measurement tool by the Nursing Faculty and Neurology specialists. The
           difficulty level of the training booklet was calculated according to Atesman's
           Readability Formula.

        -  Three patients with stroke were applied pilot scheme.

        -  Patients were included in the study according to the inclusion criteria and
           randomization list.

        -  Patients in the control and intervention groups were interviewed before discharge (0
           months). Preliminary tests were performed after obtaining informed consent from the
           patients. For this purpose, Personal Information Form, Modified Barthel Index, Stroke
           Self-Efficacy Questionnaire, Stroke Specific Quality of Life Scale were applied.
           Metabolic variables (blood pressure, height / weight assessment and laboratory findings
           [HDL cholesterol, LDL cholesterol, total cholesterol, triglyceride, HbA1c, APTT, PT and
           INR]) were obtained from the patient clinical information system.

        -  After the pre-tests, the patients were given discharge training with a booklet prepared
           based on the Chronic Care Model and containing information and recommendations on
           self-management strategies during their stay in the hospital (0 months). Trainings were
           performed in a single session and in the patient room at the clinic, not to exceed 45-50
           minutes.

        -  The patients who were included in the intervention group were followed up by telephone
           on the 7th day, 15th day, 1st month and 2nd month after discharge.

        -  Patients were referred to the hospital in unexpected / unpredictable situations during
           the three-month period.

        -  No intervention other than routine hospital follow-up was performed for the patients
           included in the control group.

        -  The patients who were included in the control and intervention groups were performed to
           post-tests at the 3rd month outpatient clinic control and metabolic variables of the
           patients were obtained from the patient clinical information system.
    

Intervention name(s): The effect of education and telephone follow ups based on the Chronic Care Model on self-management, quality of life and patient satisfaction in patients with ischemic stroke
Intervention type(s): Behavioral
Intervention description(s): The effect of education and telephone follow ups based on the Chronic Care Model on self-management, quality of life and patient satisfaction in patients with ischemic stroke Self-management, quality of life and patient satisfaction were assessed by scales at the first interview and 3 months later. Metabolic variables of the patients were obtained from the patient clinical information system at the first interview and 3 months later.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Chronic Care Model; Self-management; Stroke; Quality of Life