患者、提供者和系统层面的心力衰竭治疗障碍。

Patient-, provider-, and system-level barriers to heart failure care.

机构信息

School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.

出版信息

J Cardiovasc Nurs. 2009 Jul-Aug;24(4):290-8. doi: 10.1097/JCN.0b013e3181a660a0.

DOI:10.1097/JCN.0b013e3181a660a0

PMID:19465864

Abstract

BACKGROUND

The effectiveness of many heart failure (HF) treatments has been demonstrated, and national guidelines have been widely disseminated, yet HF care remains suboptimal. Numerous studies have examined barriers to HF care, but to date, there has been limited synthesis of these findings.

METHODS AND RESULTS

Sixty articles reporting data on barriers to HF care published between 1998 and 2007 met the criteria for inclusion in this review. Barriers to care were reported at the patient, provider, and system levels. Patient barriers were reported in 45 studies and were categorized in the main themes of knowledge, adherence, communication, functional limitations, comorbidities, psychosocial, and socioeconomic factors. Provider barriers were examined in 23 studies and included knowledge, diagnostic challenges, pharmacological concerns, communication issues, and personal factors. Barriers at the healthcare system level were reported in 13 studies and pertained to problems with organizational structure, communication, and lack of resources. Several barriers were interrelated and could not be exclusively categorized to a single level of care, with overlap also occurring within the main barrier themes.

CONCLUSIONS

Barriers to HF care were common and pervasive throughout the continuum of care. To effectively improve the quality of care and outcomes among HF patients, obstacles to HF care must be addressed at multiple levels.

摘要

背景

许多心力衰竭 (HF) 治疗方法的有效性已经得到证实，国家指南也得到了广泛传播，但 HF 护理仍然不尽如人意。许多研究都探讨了 HF 护理的障碍，但迄今为止，对这些发现的综合研究有限。

方法和结果

在 1998 年至 2007 年期间发表的 60 篇报告 HF 护理障碍数据的文章符合纳入本综述的标准。护理障碍在患者、提供者和系统层面都有报道。在 45 项研究中报告了患者障碍，并分为知识、依从性、沟通、功能限制、合并症、心理社会和社会经济因素等主要主题。在 23 项研究中检查了提供者障碍，包括知识、诊断挑战、药物治疗问题、沟通问题和个人因素。在 13 项研究中报告了医疗保健系统层面的障碍，涉及组织结构、沟通和资源缺乏等问题。一些障碍相互关联，不能单独归类于单一的护理水平，主要障碍主题内部也存在重叠。