社会差异化心脏康复是否会影响心肌梗死后的医疗服务利用？一项 10 年随访研究。

Does socially differentiated cardiac rehabilitation affect the use of healthcare services after myocardial infarction? A 10-year follow-up study.

机构信息

Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark

DEFACTUM, Social and Health Services and Labour Market, Central Denmark Region, Aarhus, Denmark.

出版信息

BMJ Open. 2019 Oct 28;9(10):e030807. doi: 10.1136/bmjopen-2019-030807.

DOI:10.1136/bmjopen-2019-030807

PMID:31662379

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6830639/

Abstract

OBJECTIVE

To examine the long-term effect of a socially differentiated cardiac rehabilitation (CR) intervention tailored to reduce social inequalities in health regarding use of healthcare services in general practice and hospital among socially vulnerable patients admitted with first-episode myocardial infarction (MI).

DESIGN

A prospective cohort study with 10 years' follow-up.

SETTING

Department of cardiology at a university hospital in Denmark between 2000 and 2004.

PARTICIPANTS

Patients <70 years admitted with first-episode MI categorised as socially vulnerable (n=208) or non-socially vulnerable (n=171) based on educational level and social network.

INTERVENTION

A socially differentiated CR intervention. The intervention consisted of standard CR and expanded CR with focus on cross-sectional collaboration.

MAIN OUTCOME MEASURES

Participation in annual chronic care consultations in general practice, contacts to general practice, all-cause hospitalisations and cardiovascular readmissions.

RESULTS

At 2-year and 5-year follow-up, socially vulnerable patients receiving expanded CR participated significantly more in annual chronic care consultations (p=0.02 and p<0.01) but at 10-year follow-up, there were no significant differences in annual chronic care consultations (p=0.13). At 10-year follow-up, socially vulnerable patients receiving standard CR had significantly more contacts to general practice (p=0.03). At 10-year follow-up, there were no significant differences in the proportion of socially vulnerable patients receiving expanded CR in the mean number of all-cause hospitalisations and cardiovascular readmissions (p>0.05).

CONCLUSIONS

The present study found no persistent association between the socially differentiated CR intervention and use of healthcare services in general practice and hospital in patients admitted with first-episode MI during a 10-year follow-up.

摘要

目的

探讨一种针对社会弱势群体的心脏康复（CR）干预措施，旨在减少健康方面的社会不平等，该措施根据丹麦一所大学医院 2000 年至 2004 年期间首次因心肌梗死（MI）入院的患者的教育水平和社交网络，将患者分为社会弱势群体（208 例）和非社会弱势群体（171 例），分析该干预措施对社会弱势群体患者在全科医生和医院中使用医疗服务的长期影响。

设计

前瞻性队列研究，随访时间 10 年。

地点

丹麦一所大学医院的心脏病科。

参与者

根据教育水平和社交网络将首次因 MI 入院的患者分为社会弱势群体（n=208）或非社会弱势群体（n=171）。

干预措施

一种社会差异化的 CR 干预措施。该干预措施包括标准的 CR 和扩展的 CR，重点是横向协作。

主要观察指标

全科医生年度慢性病咨询、全科医生就诊次数、全因住院和心血管再入院。

结果

在 2 年和 5 年的随访中，接受扩展 CR 的社会弱势群体患者接受年度慢性病咨询的比例显著更高（p=0.02 和 p<0.01），但在 10 年的随访中，两者之间没有显著差异（p=0.13）。在 10 年的随访中，接受标准 CR 的社会弱势群体患者到全科医生就诊的次数显著更多（p=0.03）。在 10 年的随访中，接受扩展 CR 的社会弱势群体患者的全因住院和心血管再入院次数没有显著差异（p>0.05）。