Autoeficacia y rehabilitación cardíaca en atención primaria de salud

Résumé

Background Self-efficacy is defined as “that refers to beliefs in one’s own abilities to organize and execute the courses of action required to handle future situation”. As a concept, is included within the global psychological theory of Bandura, known since 1986 as “social cognitive theory”. The sources of belief in relation to personal self-efficacy are in the “domain”, “vicarious” experiences, and in “social persuasión”. The expectation of self-efficacy or perceived efficacy is an important determinant of health-promoting behaviour, as well as a cognitive mediator of the stress response (people's confidence in their ability to handle the stressors they face activate the systems biological factors that mediate health and disease) and as cognitive-motivational variables that regulate effort and persistence in the chosen behaviors (exercises direct control over aspects of modifiable health behavior). Research reveals that high levels of self-efficacy have beneficial consequences for the functioning of the individual and their general well-being. In relation to preventive health behaviors, individuals with high perceived selfefficacy are more likely to initiate preventive care, seek early treatment and be more optimistic about the efficacy of these. Cardiovascular disorders, and more specifically ischemic heart disease, continue to be one of the three leading causes of death among adults in most developed countries. It is enough reason to justify the attention to people who have suffered a heart attack and who must face the complicated process of rehabilitation that such a fact advises. Cardiovascular disease is the leading cause of death in Spain, despite the fact that most of the risk factors are known and modifiable. Therefore, it is necessary to act with intensity in a disease that is very frequent, that produces a lot of morbidity and mortality and in which it is possible to reduce its prevalence, if effective preventive and rehabilitative activities are carried out. Out-of-hospital cardiac rehabilitation (RHC) is cost-effective and should be considered a part of the subacute care regimen provided to patients who have had a myocardial infarction, coronary artery bypass, percutaneous coronary interventions, valve replacement or repair, or have received a transplant of heart. Cardiac rehabilitation is able to reduce the mortality of people with coronary disease between 20 and 32%. Many problems that occur after the occurrence of a heart attack derive from the difficulties of adaptation to the consequent changes in the patient's environment and / or their inability to modify coronary risk behaviours. The psychological factors play a greater role in the course and in the treatment of the cardiovascular event. The beliefs and emotional feelings of patients regarding their own responses to their illness and its treatment can affect the outcome of the interventions in RHC. It seems therefore that for the achievement of all the objectives of the RHC, besides the medical intervention, it is necessary the psychological attention that contributes to palliate the adverse consequences of the cardiac event and to the achievement of an adequate adherence to healthy behaviours that diminish the risk of subsequent cardiac events. Hypothesis A multidimensional intervention, systematized, carried out in the field of primary care to patients, who have completed hospital HHRR activities, can improve the level of perceived self-efficacy in relation to their illness and their emotional state Objetives Main goal To determine the effect on perceived self-efficacy of an intervention in cardiac rehabilitation, in the field of primary health care, for patients who have suffered a cardiac event. Secondary objectives Know personality traits in patients who have suffered myocardial infarction, and possible associations with anxiety and/or depression questionnaires. Methodology Open, controlled and randomized community trial in primary health care. All patients who have completed a cardiac rehabilitation program during a calendar year are selected. Intervention: the subjects assigned to the intervention group carried out a series of successive visits scheduled for 12 months, assisted by family doctors. Results The main dependent variable was the difference in score between groups, comparing Medias, before and after the intervention, in the general self-efficacy scale of Baessler & Schwarner. The psychometric variables recorded were the Salamanca personality questionnaire, the Hamilton anxiety scale, and the Beck depression inventory. Out of a total of 104 selected patients, 95 participants were accepted, of which, the study period ended, and 89 analyses were included (response rate 93’68%), with an average age of 63’01 years (SD 8’75). Following the end of the study, and as its main outcome, a difference of 6.0972 points (p<0’0053, 95% CI 4’1950 to 10’29) was detected after estimation and contrast of hypotheses for population means between groups, with the intervention group being the one that showed a higher score improvement. Differences in the score on the Hamilton scale were not significant (p<0’943) nor were they significant in relation to the Beck depression inventory (p<0’8987).