Gummow L J, Gregory V R, Macnamara S E
University of Utah VA Medical Center, Salt Lake City.
Health Serv Res. 1990 Apr;25(1 Pt 2):197-211.
A decision to add a new treatment program has widespread and long-lasting implications for both the patient and the organization. Information about the interactions among the institution, the patient, and the treatment modality are seldom available. Cognitive rehabilitation is a relatively new treatment modality that is being adopted in a number of programs. This report examined characteristics of stroke patients that (1) precluded their selection for cognitive rehabilitation treatment and (2) were associated with patient refusal to participate in cognitive rehabilitation. The records of stroke patients treated in three rehabilitation facilities were examined for their ability to participate in an outpatient cognitive rehabilitation program. Due to stringent criteria for the research project, fewer than half of the stroke patient population were cognitively able to participate. Of eligible patients, many declined postdischarge cognitive rehabilitation. Several variables influenced patient participation. Female stroke patients were much less likely to participate than were male patients. In addition, distance from the medical facility providing cognitive rehabilitation was a major barrier to treatment participation. Individuals who opted to participate were well educated, affluent or both. The sample of cognitive rehabilitation patients was not, therefore, representative of the population. These results suggest that medical facilities considering the addition of a centralized outpatient postdischarge cognitive rehabilitation program should first evaluate the characteristics of the target population. Suggestions about the institutional considerations involved in making the decision to add a cognitive rehabilitation program are made.
决定增加一项新的治疗方案对患者和机构都会产生广泛而持久的影响。关于机构、患者和治疗方式之间相互作用的信息很少能获取到。认知康复是一种相对较新的治疗方式，正在许多治疗方案中被采用。本报告研究了中风患者的一些特征，这些特征一是使他们无法被选入认知康复治疗，二是与患者拒绝参与认知康复有关。对在三个康复机构接受治疗的中风患者记录进行了检查，以了解他们参与门诊认知康复项目的能力。由于该研究项目的标准严格，认知上能够参与的中风患者不到一半。在符合条件的患者中，许多人在出院后拒绝接受认知康复。有几个变量影响了患者的参与情况。女性中风患者参与的可能性远低于男性患者。此外，与提供认知康复的医疗机构的距离是参与治疗的一个主要障碍。选择参与的个体受过良好教育、富裕或两者兼备。因此，认知康复患者样本并不代表总体人群。这些结果表明，考虑增加一个集中式出院后门诊认知康复项目的医疗机构应首先评估目标人群的特征。文中还就决定增加认知康复项目所涉及的机构考量提出了建议。
