Parkosewich Janet A
Center for Professional Practice Excellence, Yale-New Haven Hospital and Yale University School of Nursing, New Haven, Connecticut 06510-3202, USA.
Cardiol Rev. 2008 Jan-Feb;16(1):36-52. doi: 10.1097/CRD.0b013e31815aff8b.
Cardiac rehabilitation is a key component of the comprehensive care of the 79.4 million adults in the United States with one or more forms of cardiovascular disease. Only a fraction of eligible candidates complete cardiac rehabilitation and women are at a significantly higher risk for underutilizing this safe and effective secondary prevention intervention. This article reviews the complex array of barriers to cardiac rehabilitation, with a focus on those factors that are unique to women. The Healthcare Utilization Model is used as a theoretical framework to categorize these barriers into environmental, physician, and patient level categories. These barriers, although challenging for both patients and healthcare professionals, provide opportunities for change. Actionable evidence-based recommendations for healthcare professionals include making changes in health policy, using proven performance improvement methodologies to increase referral and enrollment, using interdisciplinary models of communication, and enhancing cardiac rehabilitation program attributes reflective of women's preferences and needs.
心脏康复是美国7940万患有一种或多种心血管疾病的成年人综合护理的关键组成部分。只有一小部分符合条件的候选人完成了心脏康复，而女性未充分利用这种安全有效的二级预防干预措施的风险显著更高。本文回顾了心脏康复面临的一系列复杂障碍，重点关注女性特有的那些因素。医疗保健利用模型被用作理论框架，将这些障碍分为环境、医生和患者层面的类别。这些障碍虽然对患者和医疗保健专业人员都具有挑战性，但也提供了变革的机会。针对医疗保健专业人员的基于证据的可行建议包括改变卫生政策、使用经过验证的绩效改进方法来增加转诊和登记、使用跨学科沟通模式，以及增强反映女性偏好和需求的心脏康复计划属性。
