University of Missouri, Kansas City (Drs Bennett and Smith and Mss Harry, Clark, Eways, and Wilson); and Truman Medical Center, Kansas City, Missouri (Dr Smith, Mss Waters and Umhoefer, and Mr Bergland).
J Cardiopulm Rehabil Prev. 2019 Mar;39(2):97-104. doi: 10.1097/HCR.0000000000000383.
This study examined multilevel factors as predictors of cardiac rehabilitation (CR) attendance and adherence among underserved patients at a safety-net hospital (SNH).
Participants were recruited during hospitalization for a cardiac procedure or event. Participants responded to a questionnaire, and outcome data (including CR attendance and adherence) were extracted from medical records at baseline and 6 mo post-discharge.
Data were collected from 171 participants, 92 (53.8%) of whom attended CR. On average, participants completed 24 CR sessions (66.7% adherence) and 40 (43.5%) participants fully adhered to the 36 prescribed sessions. Bivariate comparisons showed that participants who attended CR were more likely to have insurance (P = .002), perceive CR as important (P = .008), believe they needed CR (P = .005), and endorsed fewer barriers to CR (P = .005) than their nonattending counterparts. After controlling for insurance status, a regression analysis to predict attendance revealed only 1 predictor; perceived lack of time (P = .04). Bivariate analyses showed that only 1 clinical factor, treatment during hospitalization, was significantly related to adherence (P = .03). Patients with medical management alone (no revascularization) showed less adherence than their counterparts with revascularization.
Although access to insurance is a significant predictor of attendance, psychological barriers that are amenable to being addressed by CR staff are also important. Findings suggest that perceived lack of time is important in SNH patient decision making to attend CR. This psychological barrier is a subject on which CR staff can intervene to educate patients about the life expectancy increases and decreased personal health care expenditures because of attendance.
本研究考察了多层次因素对服务不足患者在社区医院（SNH）接受和坚持心脏康复（CR）的预测作用。
参与者在心脏手术或事件住院期间招募。参与者回答了一份问卷，基线和出院后 6 个月时从病历中提取了结果数据（包括 CR 参与和坚持情况）。
共收集了 171 名参与者的数据，其中 92 名（53.8%）参加了 CR。参与者平均完成了 24 次 CR 课程（66.7%的依从性），40 名（43.5%）参与者完全遵守了 36 次规定的课程。双变量比较显示，参加 CR 的参与者更有可能有保险（P =.002），认为 CR 很重要（P =.008），认为自己需要 CR（P =.005），并认同 CR 的障碍较少（P =.005），而非参加者。在控制了保险状况后，预测参与的回归分析只揭示了一个预测因素；感知缺乏时间（P =.04）。双变量分析显示，只有一个临床因素，住院期间的治疗，与坚持显著相关（P =.03）。仅接受药物治疗（无血运重建）的患者比接受血运重建的患者依从性差。
尽管获得保险是参与的一个重要预测因素，但可以通过 CR 工作人员解决的心理障碍也很重要。研究结果表明，感知缺乏时间在 SNH 患者决定参加 CR 中很重要。这种心理障碍是 CR 工作人员可以干预的一个主题，教育患者参加 CR 可以延长预期寿命，并减少个人医疗保健支出。
