Patient knowledge and its role in the management of coronary heart disease

Abstract

This study examines the role that patient knowledge plays in helping patients to manage a chronic condition such as coronary heart disease (CHD). It asks two questions: firstly, what sources do CHD patients use when seeking knowledge about their condition, and what are their reasons for doing so? Secondly, do patients, in the course of managing their CHD, generate knowledge about the condition and its treatment? The study is based on a qualitative analysis of semi-structured interviews conducted with 34 patients with diagnosed CHD. It uses the grounded theory method. The study makes a contribution to knowledge in a number of areas. Firstly, it shows that the patients interviewed obtain health information from a wide variety of sources, but prefer knowledge derived through personal interaction; their knowledge-seeking appears to be influenced by the quality of their relationship with their GP. Secondly, it shows that these patients seek three distinct types of knowledge from different sources: expert knowledge from GPs and consultants; personalised practical knowledge from nurse specialists and cardiac trainers; ‘folk’ or common sense knowledge from close friends, family and other patients. Thirdly, it identifies two examples of patient-generated knowledge that could help improve CHD management – firstly, the understanding that underpins patients’ self-generated home-made health records; secondly, the patient embodied understanding that their health knowledge does not determine their health behaviours where the benefits of such knowledge are deferred. Fourthly, the study develops a theoretical model to explain how individual patient observations and practices can be converted into potentially valuable organisational knowledge. Finally, four areas are identified where health benefits may be obtained through improving current knowledge management interventions aimed at CHD patients: by using technology to assist patient involvement; by personalising cardiac rehabilitation; through the reconfiguration of long-term clinical pathways; and through better co-ordination of treatment across primary and secondary care, and across clinical specialities. As this is a qualitative study, the findings are theses, grounded in the words and actions of the patients studied. However, the new light shed on aspects of patient knowledge and the associated theoretical developments can help guide future study and encourage a re-evaluation of the effectiveness of knowledge management interventions aimed at chronic disease patients.