参与慢性心力衰竭康复的障碍：澳大利亚调查。

Barriers to Engagement in Chronic Heart Failure Rehabilitation: An Australian Survey.

机构信息

Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.

Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Vic, Australia.

出版信息

Heart Lung Circ. 2020 Aug;29(8):e177-e184. doi: 10.1016/j.hlc.2019.07.012. Epub 2019 Aug 13.

DOI:10.1016/j.hlc.2019.07.012

PMID:31521489

Abstract

BACKGROUND

While exercise has been shown to improve quality of life and physical function and reduce hospital admission rates in people with chronic heart failure (CHF), engagement is poor in condition specific rehabilitation programs. This project aims to identify barriers to engagement in rehabilitation, strategies to address these, and comprehensively detail CHF rehabilitation practise in Australia.

METHODS

An online survey was emailed to all cardiac and chronic heart failure rehabilitation programs in Australia utilising a publicly available database.

RESULTS

The survey was completed by 165 respondents: Australian Capital Territory (ACT) = 4, New South Wales (NSW) = 49, Northern Territory (NT) = 2, Queensland (Qld) = 23, South Australia (SA) = 12, Tasmania (Tas) = 2, Victoria (Vic) = 37, Western Australia (WA) = 12, including metropolitan (37%), regional (47%) and remote (9%) locations. Common barriers were themed into four areas: poor condition-specific health literacy, lack of medical professional support, interrupted health care systems, and personal and external deterrents. Strategies to improve engagement and attendance focussed mostly on the patient, with few strategies aimed at improving patient and health professional knowledge and referral processes. Programs generally appeared to follow current Australian Heart Foundation recommendations for CHF rehabilitation.

CONCLUSIONS

This survey identifies common barriers that need to be addressed to improve engagement and attendance levels in CHF rehabilitation programs. While patient barriers are already being addressed, strategic planning needs to occur to address poor health literacy including for medical and health professionals, improved flow through the health care system and improving the flexibility of program delivery. Adaptation of home-based and tele-rehabilitation can help with this, while education and advertisement to patients and potential referrers needs to start early in the disease journey.

摘要

背景

虽然运动已被证明可以提高慢性心力衰竭（CHF）患者的生活质量和身体功能，并降低住院率，但他们参与特定于疾病的康复计划的情况不佳。本项目旨在确定参与康复的障碍，解决这些障碍的策略，并全面详细介绍澳大利亚的 CHF 康复实践。

方法

利用公开的数据库，向澳大利亚所有心脏和慢性心力衰竭康复项目的电子邮件发送在线调查。

结果

165 名受访者完成了调查：澳大利亚首都领地（ACT）= 4，新南威尔士州（NSW）= 49，北领地（NT）= 2，昆士兰州（Qld）= 23，南澳大利亚州（SA）= 12，塔斯马尼亚州（Tas）= 2，维多利亚州（Vic）= 37，西澳大利亚州（WA）= 12，包括大都市（37%）、地区（47%）和偏远地区（9%）。常见障碍被分为四个主题领域：较差的特定于疾病的健康素养、缺乏医疗专业人员支持、中断的医疗保健系统以及个人和外部障碍。改善参与度和出勤率的策略主要集中在患者身上，很少有策略旨在提高患者和医疗专业人员的知识和转介流程。

结论

这项调查确定了需要解决的常见障碍，以提高 CHF 康复计划的参与度和出勤率。虽然已经在解决患者障碍，但需要进行战略规划，以解决包括医疗和卫生专业人员在内的健康素养较差、医疗保健系统流程不畅以及改善项目交付灵活性等问题。家庭和远程康复的适应可以对此有所帮助，同时需要尽早向患者和潜在转介者进行教育和宣传。