Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK.
Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK.
Int J Environ Res Public Health. 2020 Jun 2;17(11):3942. doi: 10.3390/ijerph17113942.
Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health.
运动推荐计划在随机对照试验（RCT）中显示出较小但积极的影响。对于 RCT 之后扩大规模的计划的长期效果知之甚少。威尔士国家运动推荐计划（NERS）的 RCT 于 2010 年完成，该计划在威尔士全面推广。在这项研究中，使用回顾性数据链接设计，将 NERS 数据匿名链接到 2008 年至 2017 年的转介常规健康记录。对各年的转介率和吸收率进行建模，并使用多水平逻辑回归模型检验吸收率的预测因素。共有 83598 名患者被推荐参加该计划，其中 67.31%的合格患者接受了 NERS。老年人和肌肉骨骼或四级疾病的转介更有可能接受 NERS。男性、心理健康转介、非全科医生转介和最贫困群体的患者不太可能接受 NERS。研究结果显示，与最不贫困群体相比，最贫困群体的转介率和吸收率总体呈下降趋势。研究结果表明，在 RCT 阳性结果之后，在患者社会经济地位和心理健康转介方面，推荐和吸收率的不平等程度都在扩大。
