Doolan-Noble Fiona, Broad Joanna, Riddell Tania, North Diana
The National Heart Foundation, Auckland, New Zealand.
N Z Med J. 2004 Jul 9;117(1197):U955.
To identify factors associated with patient referral to, uptake of, and completion of cardiac rehabilitation programmes in New Zealand.
Information was collected on referrals to cardiac rehabilitation during February 2002. Routinely collected hospitalisation data were obtained for men and women aged over 35 years with specified coronary episodes. The data were merged, and four predictive logistic regression models developed.
There were 2001 people either hospitalised or referred to cardiac rehabilitation. Of the 1696 hospitalised, 36% were referred for rehabilitation. After adjusting for ethnicity, women were less likely to be referred: odds ratio (OR)=0.72 [95% confidence interval (CI) 0.57-0.91]. With each 10-year age increase, there was a lower likelihood of referral (OR=0.74; 95%CI 0.67-0.82). Of those people who were referred to inpatient rehabilitation, 83% were referred to an outpatient programme. Lack of access to transport was associated with reduced likelihood of referral (OR=0.44 95%; CI 0.28-0.70) and with attendance (OR=0.54; 95%CI 0.33-0.88). Those who had previously attended a cardiac rehabilitation programme were significantly more likely to attend, and compared to those aged 65 to 74 years, those older or younger were less likely to complete the programme. Some associations with deprivation were found, but none with ethnicity.
This study demonstrated considerable scope for improvement in referral to, uptake of and completion of cardiac rehabilitation programmes in New Zealand. It highlighted the need to improve referral processes, promotion, provision, delivery and monitoring of cardiac rehabilitation services.
确定与新西兰心脏康复计划的患者转诊、参与及完成情况相关的因素。
收集了2002年2月期间心脏康复转诊信息。获取了35岁以上患有特定冠心病发作的男性和女性的常规住院数据。将数据合并，并建立了四个预测逻辑回归模型。
共有2001人住院或被转诊至心脏康复计划。在1696名住院患者中，36%被转诊至康复计划。在调整种族因素后，女性被转诊的可能性较小：优势比（OR）=0.72 [95%置信区间（CI）0.57 - 0.91]。每增加10岁，转诊的可能性就越低（OR = 0.74；95%CI 0.67 - 0.82）。在那些被转诊至住院康复的患者中，83%被转诊至门诊计划。交通不便与转诊可能性降低（OR = 0.44；95%CI 0.28 - 0.70）及参与情况（OR = 0.54；95%CI 0.33 - 0.88）相关。那些曾参加过心脏康复计划的患者再次参加的可能性显著更高，与65至74岁的患者相比，年龄较大或较小的患者完成该计划的可能性较小。发现了一些与贫困相关的关联，但与种族无关。
本研究表明新西兰在心脏康复计划的转诊、参与及完成方面有很大的改进空间。它强调了改善心脏康复服务的转诊流程、推广、提供、实施及监测的必要性。
