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全球范围内的心脏康复模式。

Cardiac Rehabilitation Models around the Globe.

作者信息

Lima de Melo Ghisi Gabriela, Pesah Ella, Turk-Adawi Karam, Supervia Marta, Lopez Jimenez Francisco, Grace Sherry L

机构信息

Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M5G2A2, Canada.

School of Kinesiology and Health Science, York University, Toronto, ON M3J1P3, Canada.

出版信息

J Clin Med. 2018 Sep 7;7(9):260. doi: 10.3390/jcm7090260.

Abstract

Alternative models of cardiac rehabilitation (CR) delivery, such as home or community-based programs, have been developed to overcome underutilization. However, their availability and characteristics have never been assessed globally. In this cross-sectional study, a piloted survey was administered online to CR programs globally. CR was available in 111/203 (54.7%) countries globally; data were collected in 93 (83.8% country response rate). 1082 surveys (32.1% program response rate) were initiated. Globally, 85 (76.6%) countries with CR offered supervised programs, and 51 (45.9%; or 25.1% of all countries) offered some alternative model. Thirty-eight (34.2%) countries with CR offered home-based programs, with 106 (63.9%) programs offering some form of electronic CR (eCR). Twenty-five (22.5%) countries with CR offered community-based programs. Where available, programs served a mean of 21.4% ± 22.8% of their patients in home-based programs. The median dose for home-based CR was 3 sessions (Q25-Q75 = 1.0⁻4.0) and for community-based programs was 20 (Q25⁻Q75 = 9.6⁻36.0). Seventy-eight (47.0%) respondents did not perceive they had sufficient capacity to meet demand in their home-based program, for reasons including funding and insufficient staff. Where alternative CR models are offered, capacity is insufficient half the time. Home-based CR dose is insufficient to achieve health benefits. Allocation to program model should be evidence-based.

摘要

为了克服利用率不足的问题,已经开发了替代的心脏康复(CR)提供模式,如居家或社区项目。然而,它们的可用性和特点从未在全球范围内得到评估。在这项横断面研究中,对全球的CR项目进行了一项在线试点调查。全球111/203个(54.7%)国家提供CR;在93个国家收集了数据(国家回复率为83.8%)。启动了1082项调查(项目回复率为32.1%)。在全球范围内,提供CR的85个(76.6%)国家提供有监督的项目,51个(45.9%;或占所有国家的25.1%)提供某种替代模式。提供CR的38个(34.2%)国家提供居家项目,其中106个(63.9%)项目提供某种形式的电子CR(eCR)。提供CR的25个(22.5%)国家提供社区项目。在有居家项目的地方,项目服务的患者平均占其患者总数的21.4%±22.8%。居家CR的中位疗程数为3次(四分位数间距Q25-Q75 = 1.0-4.0),社区项目为20次(Q25-Q75 = 9.6-36.0)。78名(47.0%)受访者认为他们没有足够的能力满足居家项目的需求,原因包括资金和人员不足。在提供替代CR模式的地方,有一半的时间能力不足。居家CR剂量不足以实现健康效益。项目模式的分配应以证据为基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd78/6162832/7604bf628d2f/jcm-07-00260-g001.jpg

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