《SARS-CoV-2 病毒（COVID-19）大流行对澳大利亚农村和偏远地区心脏康复和二级预防计划中远程医疗的快速采用的影响：一项多方法研究》。

The Impact of the SARS-CoV-2 Virus (COVID-19) Pandemic and the Rapid Adoption of Telehealth for Cardiac Rehabilitation and Secondary Prevention Programs in Rural and Remote Australia: A Multi-Method Study.

机构信息

Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.

Integrated Cardiovascular Clinical Network SA, Rural and Remote Support Services, SA Department of Health, Adelaide, SA, Australia.

出版信息

Heart Lung Circ. 2022 Nov;31(11):1504-1512. doi: 10.1016/j.hlc.2022.07.006. Epub 2022 Aug 17.

DOI:10.1016/j.hlc.2022.07.006

PMID:35987722

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9384540/

Abstract

INTRODUCTION

Centre-based cardiac rehabilitation (CR) programs were disrupted and urged to adopt telehealth modes of delivery during the COVID-19 public health emergency. Previously established telehealth services may have faced increased demand. This study aimed to investigate a) the impact of the COVID-19 pandemic on CR attendance/completion, b) clinical outcomes of patients with cardiovascular (CV) diseases referred to CR and, c) how regional and rural centre-based services converted to a telehealth delivery during this time.

METHODS

A cohort of patients living in regional and rural Australia, referred to an established telehealth-based or centre-based CR services during COVID-19 first wave, were prospectively followed-up, for ≥90 days (February to June 2020). Cardiac rehabilitation attendance/completion and a composite of CV re-admissions and deaths were compared to a historical control group referred in the same period in 2019. The impact of mode of delivery (established telehealth service versus centre-based CR) was analysed through a competitive risk model. The adaption of centre-based CR services to telehealth was assessed via a cross-sectional survey.

RESULTS

1,954 patients (1,032 referred during COVID-19 and 922 pre-COVID-19) were followed-up for 161 (interquartile range 123-202) days. Mean age was 68 (standard deviation 13) years and 68% were male. Referrals to the established telehealth program did not differ during (24%) and pre-COVID-19 (23%). Although all 10 centre-based services surveyed adopted telehealth, attendance (46.6% vs 59.9%; p<0.001) and completion (42.4% vs 75.4%; p<0.001) was significantly lower during COVID-19. Referral during vs pre-COVID-19 (sub hazard ratio [SHR] 0.77; 95% CI 0.68-0.87), and to a centre-based program compared to the established telehealth service (SHR 0.66; 95% CI 0.58-0.76) decreased the likelihood of CR uptake.

DISCUSSION

An established telehealth service and rapid adoption of telehealth by centre-based programs enabled access to CR in regional and rural Australia during COVID-19. However, further development of the newly implemented telehealth models is needed to promote CR attendance and completion.

摘要

简介

在 COVID-19 公共卫生紧急情况下，以中心为基础的心脏康复（CR）项目被迫中断，并迫切需要采用远程医疗模式进行交付。先前建立的远程医疗服务可能面临需求的增加。本研究旨在调查：a）COVID-19 大流行对 CR 出勤率/完成率的影响，b）转诊至 CR 的心血管（CV）疾病患者的临床结果，以及 c）在此期间，区域和农村以中心为基础的服务如何转换为远程医疗服务。

方法

对居住在澳大利亚偏远地区和农村地区的患者进行前瞻性随访，这些患者在 COVID-19 第一波期间被转介到一个已建立的远程医疗或中心为基础的 CR 服务，随访时间至少为 90 天（2020 年 2 月至 6 月）。比较 COVID-19 期间（2020 年）和同一时期（2019 年）转介到中心为基础的 CR 服务的患者的 CR 出勤率/完成率以及 CV 再入院和死亡的综合结果。通过竞争风险模型分析交付模式（既定远程医疗服务与中心为基础的 CR）的影响。通过横断面调查评估中心为基础的 CR 服务向远程医疗的转变。

结果

对 1954 名患者（COVID-19 期间转介的 1032 名和 COVID-19 前转介的 922 名）进行了 161 天（四分位间距 123-202）的随访。平均年龄为 68（标准差 13）岁，68%为男性。在 COVID-19 期间和 COVID-19 前，向既定远程医疗计划的转诊比例没有差异（分别为 24%和 23%）。尽管所有 10 个中心服务都采用了远程医疗，但 COVID-19 期间的出勤率（46.6% vs 59.9%；p<0.001）和完成率（42.4% vs 75.4%；p<0.001）显著降低。与 COVID-19 前相比，转诊（亚危险比[SHR]0.77；95%置信区间 0.68-0.87）和转介到中心为基础的项目而不是既定的远程医疗服务（SHR 0.66；95%置信区间 0.58-0.76）降低了 CR 接受率。