Bush Montika, Evenson Kelly R, Aylward Aileen, Cyr Julianne M, Kucharska-Newton Anna
Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Rehabil Sci. 2023 Mar 30;4:1093086. doi: 10.3389/fresc.2023.1093086. eCollection 2023.
Professional health organizations recommend that outpatient cardiac rehabilitation programs include activities to optimize the physical, mental, and social well-being of patients. The study objectives were to describe among cardiac rehabilitation programs (1) mental health assessments performed; (2) psychosocial services offered; and (3) leadership's perception of barriers to psychosocial services offerings.
A cross-sectional survey of North Carolina licensed outpatient cardiac rehabilitation programs on their 2018 services was conducted. Descriptive statistics were used to summarize survey responses. Thematic analysis of free text questions related to barriers to programmatic establishment or expansion of psychosocial services was performed by two team members until consensus was reached.
Sixty-eight programs (89%) responded to the survey. Forty-eight programs (70%) indicated offering psychosocial services; however, a majority (73%) of programs reported not directly billing for those services. At program enrollment, mental health was assessed in 94% of programs of which 92% repeated the assessment at discharge. Depression was assessed with the 9-item Patient Health Questionnaire by a majority (75%) of programs. Psychosocial services included individual counseling (59%), counseling referrals (49%), and educational classes (29%). Directors reported lack of internal resources (92%) and patient beliefs (45%) as the top barriers to including or expanding psychosocial services at their facilities.
Cardiac rehabilitation programs routinely assess mental health but lack the resources to establish or expand psychosocial services. Interventions aimed at improving patient education and reducing stigma of mental health are important public health opportunities.
专业健康组织建议门诊心脏康复项目应包括旨在优化患者身体、心理和社会福祉的活动。本研究的目的是描述心脏康复项目中：（1）所进行的心理健康评估；（2）提供的心理社会服务；以及（3）领导层对心理社会服务提供障碍的看法。
对北卡罗来纳州获得许可的门诊心脏康复项目2018年的服务进行了横断面调查。使用描述性统计来总结调查回复。由两名团队成员对与心理社会服务项目设立或扩展障碍相关的自由文本问题进行主题分析，直至达成共识。
68个项目（89%）回复了调查。48个项目（70%）表示提供心理社会服务；然而，大多数项目（73%）报告这些服务不直接计费。在项目登记时，94%的项目对心理健康进行了评估，其中92%在出院时重复了评估。大多数项目（75%）使用9项患者健康问卷对抑郁症进行评估。心理社会服务包括个体咨询（59%）、咨询转诊（49%）和教育课程（29%）。主任们报告称，缺乏内部资源（92%）和患者观念（45%）是其机构纳入或扩展心理社会服务的首要障碍。
心脏康复项目常规评估心理健康，但缺乏建立或扩展心理社会服务的资源。旨在改善患者教育和减少心理健康污名化的干预措施是重要的公共卫生机会。
