加拿大心脏健康战略和行动计划：心脏康复作为慢性病管理的典范。

The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management.

机构信息

McMaster University, Hamilton, Ontario, Canada.

出版信息

Can J Cardiol. 2010 Jan;26(1):37-41. doi: 10.1016/s0828-282x(10)70336-6.

DOI:10.1016/s0828-282x(10)70336-6

PMID:20101356

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2827223/

Abstract

BACKGROUND

In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009.

OBJECTIVES

The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD.

METHODS

TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP.

RESULTS

Specific actionable recommendations for CR are made in accordance with the key principles of the CCM.

CONCLUSIONS

The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada.

摘要

背景

2006 年 10 月，加拿大联邦政府宣布为制定全国防治心血管疾病（CVD）战略提供资金。2009 年 2 月 24 日，全面、独立、由利益攸关方驱动的加拿大心脏健康战略和行动计划（CHHS-AP）提交给了卫生部长。

目的

CHHS-AP 主题工作组（TWG）6 的任务是确定最佳的慢性病管理模式，该模式将及时获得康复服务以及临终规划和护理纳入其中。本文件的目的是概述全球 CVD 和心脏康复（CR）策略的方法，并在广为人知的慢病管理模式（CCM）的背景下，为加拿大的 CR 护理提供建议。另一篇论文将讨论 CVD 患者的临终问题。

方法

TWG 6 由内容代表、初级保健代表和患者组成。通过个别专家咨询获得了关于原住民心血管健康的投入。与本文件相关的信息是从国际文献和最佳实践指南中收集的。CCM 原则得到了所有成员的讨论和认可。在整个 TWG 内讨论并决定了建议的优先级和总体信息。整个 TWG 报告提交给了 CHHS-AP 指导委员会，并为 CHHS-AP 的建议提供了信息。