York University & University Health Network, Toronto, Ontario, Canada.
BMC Health Serv Res. 2012 Aug 16;12:259. doi: 10.1186/1472-6963-12-259.
In 2006, the Canadian Cardiovascular Society (CCS) Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR). The objectives of the current study were to: (1) describe cardiac patient perceptions of actual and ideal CR wait times, (2) describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3) investigate actual wait times and factors that CR programs perceive to affect these wait times.
Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared.
Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate), and 92 CR programs (61.7% response rate). Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days), while their ideal median wait time was 28 days. Most patients (91.5%) considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p < 0.05). CR programs reported that feasible wait times were significantly longer than what was appropriate for all indications (p < 0.05). They perceived that patient travel and staff capacity were the main factors negatively affecting waits. The median wait time from referral to program initiation was 64 days (mean, 80.0 ± 62.8 days), with no difference in wait by indication.
Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.
2006 年，加拿大心血管学会（CCS）获取护理工作组建议心脏康复（CR）的 30 天等待时间基准。本研究的目的是：（1）描述心脏患者对实际和理想 CR 等待时间的看法，（2）描述和比较心脏专家和 CR 计划对等待时间的看法，以及建议是否合适和可行，（3）调查实际等待时间以及 CR 计划认为影响这些等待时间的因素。
向 8 个项目中的 1 个项目的 CR 参与者、所有接受 CR 治疗的 CCS 成员心脏专家以及加拿大目录中列出的所有 CR 项目发送了关于 CR 等待时间的看法的邮政和在线调查。实际等待时间从加拿大心脏康复登记处确定。设计为横断面。描述并比较了结果。
收到了 163 名 CR 参与者、71 名心脏专家（9.3%的回应率）和 92 个 CR 项目（61.7%的回应率）的回复。患者报告称，他们从出院到开始 CR 的等待时间为 65.6±88.4 天（中位数为 42 天），而他们的理想中位数等待时间为 28 天。大多数患者（91.5%）认为他们的等待时间可以接受，但不同类型的心脏 CR 指征的理想等待时间差异很大。在大多数指征下，专家和计划对等待天数的看法存在显著差异，CR 计划认为等待较短时间更合适（p<0.05）。CR 计划报告称，可行的等待时间明显长于所有指征的适当时间（p<0.05）。他们认为患者旅行和员工能力是影响等待的主要因素。从转介到项目启动的中位等待时间为 64 天（平均值为 80.0±62.8 天），不同指征的等待时间没有差异。
与共识建议相比，心脏康复后的等待时间延长，但大多数患者普遍接受。特别是经皮冠状动脉介入治疗后的等待时间可能需要缩短。需要进一步研究为等待时间基准提供证据基础。
