Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study
Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study
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DOI：
10.1097/hjr.0b013e328305df05
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发表时间：
2008-10-01
影响因子：
--
通讯作者：
Stewart, Donna E.
中科院分区：
文献类型：
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作者：
Grace, Sherry L.;Gravely-Witte, Shannon;Stewart, Donna E.
背景心脏康复（CR）是一种降低死亡率的既定手段，但严重利用不足。这是由于卫生系统和患者层面的因素;这些问题尚未同时调查。本研究采用了分层设计，以检查医生和患者水平的因素影响验证CR enrollment.Design前瞻性的多站点研究，使用多层次设计的1490冠状动脉疾病门诊嵌套在97安大略心脏病学的做法（平均15个心脏病学家）。对门诊患者进行前瞻性调查，以评估影响CR入组的因素。患者在9个月后邮寄随访调查，以自我报告CR入组。结果共转诊患者550例（43.4%），CR患者469例（37.0%）。混合Logistic回归分析显示，影响CR入组的因素有：医生的支持力度大（P=0.005）、距离CR的距离短（P = 0.001）、已婚（P=0.01）、CR障碍少（P=0.03）。患者CR障碍应在转诊讨论期间解决，以及医生未能统一支持CR探索的原因。虽然CR的距离与患者入组模式有关，但应提供更多的家庭CR服务。欧洲心脏病学会康复杂志15：548-556（C）2008
Background Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This Study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment.Design A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist).Methods Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites.Results Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03).Conclusion Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided. Eur J Cardiovasc Prev Rehabil 15:548-556 (C) 2008 The European Society of Cardiology