Department of Psychological Sciences, Kent State University, Kent, OH 44242, United States of America.
Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Bio-behavioral Medicine, Charleston, SC 29425, United States of America.
Prog Cardiovasc Dis. 2022 Jul-Aug;73:76-83. doi: 10.1016/j.pcad.2021.12.006. Epub 2022 Jan 10.
Psychosocial management is a core component of outpatient Phase-II cardiac rehabilitation (CR) and includes psychosocial assessment, providing interventions, measuring outcomes, and care coordination. Psychosocial management contributes to the effectiveness of comprehensive CR, but the implementation is not always consistent or clearly described in the literature, in part due to the availability of behavioral health specialists. Patients in CR have many psychosocial needs including anxiety, depression, substance use disorders, sleep problems, psychosocial stress, and cognitive impairment. Behavioral considerations are inherent in many other aspects of CR,such as participation in CR, health behaviors, adherence, and tobacco cessation. Evaluation, or psychosocial assessment, should identify significant issues, record related medications, and incorporate findings in the individual treatment plan. Some patients require further evaluation and treatment by a qualified behavioral health specialist. Psychosocial interventions provided to all patients include patient education, counseling, stress-management, a supportive environment, and exercise. Measuring outcomes entails repeating the psychosocial assessment when patients finish CR and documenting changes. Coordinating care requires understanding available local mental health infrastructure and procedures for making referrals, and may entail identifying additional resources. Interventions provided concurrently with CR to a subset of patients with more extensive needs are typically pharmacotherapy, psychotherapy, or addictions counseling, which are beyond the scope of practice for most CR professionals. The way psychosocial management is implemented suggests clinical and research opportunities. For example, the combined effects of antidepressants and CR on depression and anxiety are not known. A prominent clinical opportunity is to fully implement psychosocial assessment, as required by statute and the core components. This could involve referring patients for whom clinically significant psychosocial concerns are identified during the evaluation for a more thorough assessment by a behavioral health specialist using an appropriate billing model. A research priority is a contemporary description of behavioral health services available to CR programs, including how psychosocial management is implemented. As delivery of CR comes to include more alternative models (e.g., home-based), research is needed on how that affects the delivery of psychosocial management. Increased use of telehealth may broaden clinical opportunities for psychosocial management.
心理社会管理是门诊二期心脏康复（CR）的核心组成部分，包括心理社会评估、提供干预措施、测量结果和护理协调。心理社会管理有助于综合 CR 的有效性，但在文献中实施并不总是一致或明确描述，部分原因是行为健康专家的可用性。CR 患者有许多心理社会需求，包括焦虑、抑郁、物质使用障碍、睡眠问题、心理社会压力和认知障碍。行为因素存在于 CR 的许多其他方面，例如参与 CR、健康行为、依从性和戒烟。评估或心理社会评估应确定重大问题，记录相关药物，并将发现纳入个体治疗计划。一些患者需要由合格的行为健康专家进一步评估和治疗。提供给所有患者的心理社会干预措施包括患者教育、咨询、压力管理、支持环境和运动。衡量结果需要在患者完成 CR 后重复进行心理社会评估并记录变化。协调护理需要了解可用的当地心理健康基础设施和转介程序，并可能需要确定其他资源。对更广泛需求的亚组患者同时提供的干预措施通常是药物治疗、心理治疗或成瘾咨询，这些超出了大多数 CR 专业人员的实践范围。心理社会管理的实施方式表明了临床和研究机会。例如，抗抑郁药和 CR 对抑郁和焦虑的联合作用尚不清楚。一个突出的临床机会是充分实施心理社会评估，这是法规和核心组件所要求的。这可能涉及将在评估期间发现有临床意义的心理社会问题的患者转介给行为健康专家，由其使用适当的计费模式进行更全面的评估。一个研究重点是 CR 计划可用的行为健康服务的现代描述，包括心理社会管理的实施方式。随着 CR 的提供开始包括更多替代模式（例如，家庭为基础），需要研究这如何影响心理社会管理的提供。远程医疗的使用增加可能会为心理社会管理提供更广泛的临床机会。
