Trial document





This trial has been registered retrospectively.
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  DRKS00007839

Trial Description

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Title

How socioeconomic inequalities impact pathways of care for coronary artery disease. A qualitative study from the view of multimorbid elderly patients

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Trial Acronym

BeHerzt

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URL of the Trial

http://www.ims.uni-halle.de/forschung/forschungsprojekte/laufende_projekte/beherzt/

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Brief Summary in Lay Language

International studies showed inequalities in access and utilization, but also with respect to the quality of cardiac care, to the disadvantage of patients with low socioeconomic status. The aim of this qualitative longitudinal study is to investigate the impact of socioeconomic inequalities on the access to, and the utilization and quality of healthcare services during the particular stages of healthcare for CAD patients. Therefore Patients with CAD, aged 60-80 years, are recruited consecutively over a period of six months at the Department of Internal Medicine III (Cardiology and Angiology) at the University Hospital Halle/Saale, Germany. The patients will be interviewed face-to-face during their hospital stay and once again after 6 months, using semi-structured guided interviews.

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Brief Summary in Scientific Language

Coronary artery disease (CAD) is the leading cause of death in Europe. Countless medical, sociological and epidemiological studies have been able to demonstrate socioeconomic inequalities in CAD to the disadvantage of patients with low socioeconomic status (SES). Despite the relatively accurate diagnostic criteria and established therapeutic principles, international studies showed inequalities in access and utilization, but also with respect to the quality of cardiac care, to the disadvantage of patients with low SES. This study will investigate socioeconomic inequality in access, utilization and quality across different stages of care in CAD, from hospitalisation in an acute care clinic to rehabilitation and subsequent outpatient treatment by a general practitioner and a cardiac specialist. Therefore 60 patients, aged 60-80 years, with CAD are recruited consecutively over a period of six months at the Department of Internal Medicine III (Cardiology and Angiology) at the University Hospital Halle/Saale, Germany. Patients will be interviewed face-to-face using guided interviews at the acute hospital and six months after the discharge from the acute hospital. Using a qualitative sampling plan, patients with the most frequent clinical manifestations – stable angina pectoris, acute coronary syndrome and cardiac arrhythmia – will be selected and grouped. Of the twenty patients with each clinical manifestation, ten will be selected from a low and ten from a high SES group. The data will be analysed in accordance with Glaser and Strauss’s rules of Grounded Theory.

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Organizational Data

  •   DRKS00007839
  •   2015/02/25
  •   [---]*
  •   yes
  •   Approved
  •   2014-95, Ethikkommission der Medizinischen Fakultät der Martin-Luther-Universität Halle Wittenberg
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Secondary IDs

  • [---]*
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Health Condition or Problem studied

  •   I25 -  Chronic ischaemic heart disease
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Interventions/Observational Groups

  •   60 Patients with CAD, aged 60-80 years, are recruited consecutively over a period of six months at the Department of Internal Medicine III (Cardiology and Angiology) at the University Hospital Halle/Saale, Germany. Patients are interviewed during their hospital stay and once again after 6 months. The interviews will be conducted face-to-face using semi-structured guided interviews. Using a qualitative sampling plan patients with the most frequent clinical manifestations – stable angina pectoris, acute coronary syndrome and cardiac arrhythmia – will be selected and grouped. Of the twenty patients with each clinical manifestation, ten will be selected from a low and ten from a high SES group.
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Characteristics

  •   Non-interventional
  •   Observational study
  •   Single arm study
  •   Open (masking not used)
  •   [---]*
  •   Uncontrolled/Single arm
  •   Health care system
  •   Single (group)
  •   N/A
  •   N/A
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Primary Outcome

The Interviews will be conducted face-to-face using guided interviews. The themes of the interviews will be the medical history, positive and negative experiences gained concerning the received care, the perceived quality of the treatment and the management of the heart disease. The aim is to answer the following research questions:
1. What impact do socioeconomic inequalities have on the access to, and the utilization and quality of healthcare services during the particular stages of healthcare for CAD patients?
2. Can specific factors and mechanisms be identified that lead to inequality of health-care?
3. How do socioeconomic inequalities interact and accumulate over the course of treatment and care?

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Secondary Outcome

After 6 months face-to-face Interviews using a interview-guided will be conducted. The themes of the interviews will be the progressing of the treatment, positive and negative experiences gained concerning the received care, and the influence of the heart disease on everyday life. The aim is to answer the following research questions:
1. What impact do socioeconomic inequalities have on the access to, and the utilization and quality of healthcare services during the particular stages of healthcare for CAD patients?
2. Can specific factors and mechanisms be identified that lead to inequality of health-care?
3. How do socioeconomic inequalities interact and accumulate over the course of treatment and care?

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • University Medical Center 
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Recruitment

  •   Actual
  •   2014/11/06
  •   60
  •   Monocenter trial
  •   National
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Inclusion Criteria

  •   Both, male and female
  •   60   Years
  •   80   Years
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Additional Inclusion Criteria

patients being treated at the at the University Hospital Halle/Saale, Department of Internal Medicine III (Cardiology and Angiology), aged 60-80 years old, with CAD as the principal or secondary diagnosis, and additionally one other principal or secondary diagnosis: stable angina pectoris, acute coronary syndrome or cardiac arrhythmia

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Exclusion Criteria

insufficient language skills to conduct an interview in German language, other heart diseases excluding CAD, and/or moribund patients

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Addresses

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    • Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
    • Mr.  Prof. Dr.  Matthias  Richter 
    • Magdeburger Str. 8
    • 06112  Halle
    • Germany
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    • Institut für Medizinische Soziologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
    • Ms.  Sara  Schröder 
    • Magdeburger Str. 8
    • 06112  Halle
    • Germany
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    • Institut für Medizinische SoziologieMedizinische FakultätMartin-Luther-Universität Halle-Wittenberg
    • Ms.  Sara  Schröder 
    • Magdeburger Str. 8
    • 06112  Halle
    • Germany
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    end of 1:1-Block address contact public-contact
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Sources of Monetary or Material Support

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    • Wilhelm-Roux-Programm zur Nachwuchs- und Forschungsförderung der Medizinischen Fakultät der Martin-Luther-Universität Halle-Wittenberg
    • Mr.  Prof. Dr. med. habil.  Dirk  Vordermark 
    • Magdeburger Straße 8
    • 06112  Halle (Saale)
    • Germany
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Status

  •   Recruiting complete, follow-up complete
  •   2015/10/27
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* This entry means the parameter is not applicable or has not been set.