Factors influencing referral to cardiac rehabilitation and secondary prevention programs: a systematic review
Factors influencing referral to cardiac rehabilitation and secondary prevention programs: a systematic review
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DOI：
10.1177/2047487312447846
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发表时间：
2013-08-01
影响因子：
8.3
通讯作者：
Angus, Jan
中科院分区：
文献类型：
--
作者：
Clark, Alexander M.;King-Shier, Kathryn M.;Angus, Jan
背景资料：转介心脏康复和二级预防计划仍然非常低，尽管有证据表明强大的临床疗效。为了制定循证干预措施以促进转诊，需要更好地了解影响转诊的复杂因素和过程。设计：我们进行了一个系统的评价，采用定性荟萃综合。方法：全面检索11个数据库。要被纳入，研究必须包含一个定性的研究组成部分，全部或在一个混合的方法设计。人口特定数据或主题必须是可提取的，以便转介给方案。研究必须包含18岁以上成年人的可提取数据，并在1995年期间或之后作为论文全文或论文发表。结果如下：共检索到2620篇文章：在检查的1687项研究中，87项研究包含与参与计划的决定有关的数据，其中34项包含转诊数据。医疗保健专业人员，系统和患者因素影响转诊。主要的专业障碍是知识不足或对益处持怀疑态度，过度依赖医生作为守门人，以及认为患者不太可能参与。与领土、薪酬以及时间和工作量能力不足有关的系统因素。患者对计划的了解有限，并将医生视为转诊的关键因素，但发现获得转诊的过程令人困惑且具有挑战性。结论：通过允许非医生转诊或自动转诊到医院或家庭方案的选择，可以实现患者转诊到方案的最大增长。所有转介的卫生专业人员都应接受围绕方案伦理和临床方面的教育外展访问或研讨会。
Background: Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood. Design: We performed a systematic review using qualitative meta-synthesis. Methods: A comprehensive search of 11 databases was conducted. To be included, studies had to contain a qualitative research component wholly or in a mixed method design. Population specific data or themes had to be extractable for referral to programs. Studies had to contain extractable data from adults >18 years and published as full papers or theses during or after 1995. Results: A total of 2620 articles were retrieved: out of 1687 studies examined, 87 studies contained data pertaining to decisions to participate in programs, 34 of which included data on referral. Healthcare professional, system and patient factors influenced referrals. The main professional barriers were low knowledge or scepticism about benefits, an over-reliance on physicians as gatekeepers and judgments that patients were not likely to participate. Systems factors related to territory, remuneration and insufficient time and workload capacity. Patients had limited knowledge of programs and saw physicians as key elements of referral but found the process of attaining a referral confusing and challenging. Conclusions: The greatest increases in patient referral to programs could be achieved by allowing referral from non-physicians or alternatively, automatic referral to a choice of hospital or home-based programs. All referring health professionals should receive educational outreach visits or workshops around the ethical and clinical aspects of programs.