Shareheart: Using patient journey mapping for health care optimization in patients with ischemia and non-obstructive coronary arteries (INOCA)

Background:

Ischemia with non-obstructive coronary arteries (INOCA) is a chronic cardiac condition characterized by vascular dysfunction. INOCA is often underrecognized and more prevalent in women. Patients’ experiences remain unexplored and a clear patient centered care pathway is lacking. We aimed to visualize patients’
health care pathway (journey) by exploring the experiences and needs
of patients with INOCA. The method of ‘patient journey mapping’ will be used, which is a patient-centered design approach for designing health care solutions.

Method:

In total 36 women were recruited in two Dutch hospitals and participated in eight online semi-structured focus group interviews. Transcriptions were analyzed according to a thematic analysis. Themes were further classified using a combination of ‘process’ and ‘patient journey’ mapping. The former method was
used to visualize reported contact moments/steps (touchpoints), the latter adds a layer of experiences and needs to the patient journey. Picker’s eight principles of patient-centered care framework were integrated into the patient journey map to highlight which principles need improvement according to the patients’ view. This may support implementation steps towards a patient-centered care pathway.

Results:

Process mapping shows a complex and unstructured health care pathway. Participants faced various barriers including a lack of familiarity with INOCA by health care providers, repeated hospitalization, testing and referrals, feelings of not being heard, shortage of specialized INOCA cardiologists, the lack of a multidisciplinary treatment program (including physical and
psychological support), and the absence of a contact person/specialized nurse practitioner.

Conclusion:

The resulting visual tool shows how patients experienced and interacted with the current health care system and can be used for future healthcare quality improvement towards a more patient-centered care pathway. More familiarity and knowledge regarding INOCA is needed as well as an adequate referral system in
both early and later stages of the pathway. In the future, research should focus on the development and implementation of a patient centered evidence-based clinical pathway, taking into account sex and gender differences.