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2.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32548994

RESUMO

The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units.  The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak.


Assuntos
Reabilitação Cardíaca/normas , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Síndrome Coronariana Aguda/reabilitação , Reabilitação Cardíaca/psicologia , Cardiotônicos/efeitos adversos , Cardiotônicos/uso terapêutico , Exercício Físico , Feminino , Insuficiência Cardíaca/reabilitação , Humanos , Itália/epidemiologia , Masculino , Terapia Nutricional , Pandemias , Tromboembolia/reabilitação
3.
Medicine (Baltimore) ; 99(17): e19874, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332655

RESUMO

INTRODUCTION: Heart transplantation (HT) is known to be the final therapy for patients with advanced heart failure; however, the exercise capacity of these patients remains under the aged-predicted value after HT. Many studies have described the effectiveness and safety of cardiac rehabilitation (CR) in HT recipients. Nevertheless, long-term follow-up data of HT recipients undergoing CR are insufficient, and there is a lack of evidence on the long-term effects of CR. In this case report, we present the long-term benefits of CR in an HT recipient, including serial follow-up clinical data over 1 year. PATIENT CONCERNS: A 48-year-old female patient underwent HT because of advanced dilated cardiomyopathy. DIAGNOSIS: Cardiopulmonary exercise test showed reduced exercise capacity and pulmonary function. The grip power and quadriceps muscle strength were also decreased after HT. INTERVENTIONS: The patient underwent a phase I CR program for 3 months, followed by a phase III CR program for 7 months. In the beginning, moderate-intensity continuous training was conducted. Thereafter, high-intensity interval training was implemented after a period of adjustment for interval training. OUTCOMES: The exercise capacity, 6-min walk distance, muscle strength, and vital capacity were improved after CR. CONCLUSION: CR in HT recipients may improve muscle strength and pulmonary function as well as exercise capacity, without serious cardiovascular complications. Phase III CR may help maintain exercise capacity in these patients.


Assuntos
Assistência ao Convalescente/métodos , Reabilitação Cardíaca/normas , Transplante de Coração/reabilitação , Resultado do Tratamento , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Terapia por Exercício/métodos , Tolerância ao Exercício , Feminino , Transplante de Coração/psicologia , Transplante de Coração/normas , Humanos , Pessoa de Meia-Idade
4.
Artigo em Inglês | MEDLINE | ID: mdl-32033503

RESUMO

For health services, improving organizational health literacy responsiveness is a promising approach to enhance health and counter health inequity. A number of frameworks and tools are available to help organizations boost their health literacy responsiveness. These include the Ophelia (OPtimising HEalth LIteracy and Access) approach centered on local needs assessments, co-design methodologies, and pragmatic intervention testing. Within a municipal cardiac rehabilitation (CR) setting, the Heart Skills Study aimed to: (1) Develop and test an organizational health literacy intervention using an extended version of the Ophelia approach, and (2) evaluate the organizational impact of the application of the Ophelia approach. We found the approach successful in producing feasible organizational quality improvement interventions that responded to local health literacy needs such as enhanced social support and individualized care. Furthermore, applying the Ophelia approach had a substantial organizational impact. The co-design process in the unit helped develop and integrate a new and holistic understanding of CR user needs and vulnerabilities based on health literacy. It also generated motivation and ownership among CR users, staff, and leaders, paving the way for sustainable future implementation. The findings can be used to inform the development and evaluation of sustainable co-designed health literacy initiatives in other settings.


Assuntos
Reabilitação Cardíaca/normas , Guias como Assunto , Letramento em Saúde/normas , Pessoal de Saúde/educação , Promoção da Saúde/normas , Serviços de Saúde/normas , Melhoria de Qualidade/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
BMJ Open ; 9(12): e032279, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796485

RESUMO

OBJECTIVE: To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme. DESIGN: Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes. PARTICIPANTS: An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential). MAIN OUTCOME MEASURE: Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted. RESULTS: 49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted. CONCLUSIONS: For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.


Assuntos
Reabilitação Cardíaca/normas , Guias de Prática Clínica como Assunto/normas , Austrália , Consenso , Técnica Delfos , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino
7.
Prev Med ; 128: 105865, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31662210

RESUMO

Participation in secondary prevention programs such as cardiac rehabilitation (CR) reduces morbidity, mortality, and hospitalizations while improving quality of life. Executive function (EF) is a complex set of cognitive abilities that control and regulate behavior. EF predicts many health-related behaviors, but how EF interacts with interventions to improve treatment adherence is not well understood. The objective of this study is to examine if EF predicts CR treatment adherence and how EF interacts with an intervention to improve adherence. Data were collected from 2013 to 2018 in Vermont, USA. 130 Medicaid-enrolled individuals who had experienced a qualifying cardiac event were enrolled in a controlled clinical trial and randomized 1:1 to receive financial incentives for completing secondary prevention sessions or to usual care. In this secondary analysis, effects of EF on CR adherence (defined as completing ≥30/36 sessions) were examined in 112 participants (57 usual care, 55 intervention) who completed an EF battery. Delay-discounting, a measure of impulsivity, predicted CR adherence (p = 0.01) and interacted with the incentive intervention, such that those who exhibited greater discounting of future rewards benefitted more from the intervention than those who discounted less (F(1, 104) = 5.23, p = 0.02). Better cognitive flexibility, measured with the trail-making-task, also predicted CR adherence (p = 0.02). While EF has been associated with adherence to a variety of treatment regimens, this interaction between an incentive-based intervention to promote treatment adherence and EF is novel. This work illustrates the value of considering individual differences in EF when designing and implementing interventions to promote health-related behavior change.


Assuntos
Reabilitação Cardíaca/psicologia , Reabilitação Cardíaca/normas , Cardiopatias/prevenção & controle , Motivação , Prevenção Secundária/estatística & dados numéricos , Cooperação e Adesão ao Tratamento/psicologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Arch Cardiovasc Dis ; 112(11): 723-731, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542331

RESUMO

Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.


Assuntos
Reabilitação Cardíaca/normas , Terapia por Exercício/normas , Insuficiência Cardíaca/terapia , Reabilitação Cardíaca/efeitos adversos , Consenso , Terapia por Exercício/efeitos adversos , Tolerância ao Exercício , França , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Cooperação do Paciente , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
9.
Heart ; 105(23): 1806-1812, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31253695

RESUMO

OBJECTIVE: Cardiac rehabilitation (CR) availability, programme characteristics and barriers are not well-known in low/middle-income countries (LMICs). In this study, they were compared with high-income countries (HICs) and by CR funding source. METHODS: A cross-sectional online survey was administered to CR programmes globally. Need for CR was computed using incident ischaemic heart disease (IHD) estimates from the Global Burden of Disease study. General linear mixed models were performed. RESULTS: CR was identified in 55/138 (39.9%) LMICs; 47/55 (85.5% country response rate) countries participated and 335 (53.5% programme response) surveys were initiated. There was one CR spot for every 66 IHD patients in LMICs (vs 3.4 in HICs). CR was most often paid by patients in LMICs (n=212, 65.0%) versus government in HICs (n=444, 60.2%; p<0.001). Over 85% of programmes accepted guideline-indicated patients. Cardiologists (n=266, 89.3%), nurses (n=234, 79.6%; vs 544, 91.7% in HICs, p=0.001) and physiotherapists (n=233, 78.7%) were the most common providers on CR teams (mean=5.8±2.8/programme). Programmes offered 7.3±1.8/10 core components (vs 7.9±1.7 in HICs, p<0.01) over 33.7±30.7 sessions (significantly greater in publicly funded programmes; p<0.001). Publicly funded programmes were more likely to have social workers and psychologists on staff, and to offer tobacco cessation and psychosocial counselling. CONCLUSION: CR is only available in 40% of LMICs, but where offered is fairly consistent with guidelines. Governments should enact policies to reimburse CR so patients do not pay out-of-pocket.


Assuntos
Reabilitação Cardíaca/estatística & dados numéricos , Assistência à Saúde/organização & administração , Países em Desenvolvimento , Reabilitação Cardíaca/economia , Reabilitação Cardíaca/normas , Estudos Transversais , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Modelos Organizacionais
10.
Soc Work Health Care ; 58(7): 633-650, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31244394

RESUMO

Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.


Assuntos
Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/psicologia , Geriatria/organização & administração , Serviços de Saúde Mental/organização & administração , Serviço Social/organização & administração , Idoso , Reabilitação Cardíaca/normas , Relações Comunidade-Instituição , Humanos , Serviços de Saúde Mental/normas , Papel Profissional , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/organização & administração , Integração de Sistemas
13.
Nurs Health Sci ; 21(3): 406-412, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31140206

RESUMO

In Portugal, cardiovascular diseases stand out among the main causes of morbidity, disability, and mortality, with an expectation of growth up to the year 2025. A descriptive, exploratory study was carried out with patients in a cardiac rehabilitation program from an institution in the northern region of Portugal; 103 participants were randomly selected for the study. The data collection took place from February to April 2017. The majority of respondents presented a low level of literacy (inadequate and problematic). The profiles of the participants were characterized by the predominance of married males, with a mean age of 69 years. The participants considered doctors and nurses as the professionals who contribute the most to the increase of their health literacy. These health professionals have the opportunity and the responsibility to increase the health literacy levels of patients. It is known that low levels of health literacy are a problem throughout the European Union. Portugal's general population reflects this reality, and this study contributed to the conclusion that cardiac rehabilitation patients also present worrying levels of health literacy.


Assuntos
Reabilitação Cardíaca/métodos , Letramento em Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/normas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Avaliação de Programas e Projetos de Saúde/métodos , Estatísticas não Paramétricas
14.
J Am Coll Cardiol ; 74(1): 133-153, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31097258

RESUMO

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.


Assuntos
Reabilitação Cardíaca/normas , Serviços de Assistência Domiciliar/normas , Reabilitação Cardíaca/métodos , Humanos
15.
Circulation ; 140(1): e69-e89, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31082266

RESUMO

Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.


Assuntos
American Heart Association , Reabilitação Cardíaca/normas , Cardiologia/normas , Doenças Cardiovasculares/terapia , Serviços de Assistência Domiciliar/normas , Pneumopatias/reabilitação , Reabilitação Cardíaca/métodos , Cardiologia/métodos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/normas , Terapia por Exercício/métodos , Terapia por Exercício/normas , Humanos , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Estados Unidos/epidemiologia
16.
Eur J Prev Cardiol ; 26(14): 1483-1492, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31046441

RESUMO

When added to endurance training, dynamic strength training leads to significantly greater improvements in peripheral muscle strength and power output in patients with cardiovascular disease, which may be relevant to enhance the patient's prognosis. As a result, dynamic strength training is recommended in the rehabilitative treatment of many different cardiovascular diseases. However, what strength training intensity should be selected remains under intense debate. Evidence is nonetheless emerging that high-intensity strength training (≥70% of one-repetition maximum) is more effective to increase acutely myofibrillar protein synthesis, cause neural adaptations and, in the long term, increase muscle strength, when compared to low-intensity strength training. Moreover, multiple studies report that high-intensity strength training causes fewer increments in (intra-)arterial blood pressure and cardiac output, as opposed to low-intensity strength training, thus potentially pointing towards sufficient medical safety for the cardiovascular system. The aim of this systematic review is therefore to discuss this line of evidence, which is in contrast to current clinical practice, and to re-open the debate as to what dynamic strength training intensities should actually be applied.


Assuntos
Reabilitação Cardíaca/métodos , Doença Arterial Periférica/reabilitação , Treinamento de Resistência , Adulto , Idoso , Reabilitação Cardíaca/normas , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Guias de Prática Clínica como Assunto , Recuperação de Função Fisiológica , Treinamento de Resistência/normas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Circulation ; 139(21): e997-e1012, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-30955352

RESUMO

Cardiovascular disease is a competing cause of death in patients with cancer with early-stage disease. This elevated cardiovascular disease risk is thought to derive from both the direct effects of cancer therapies and the accumulation of risk factors such as hypertension, weight gain, cigarette smoking, and loss of cardiorespiratory fitness. Effective and viable strategies are needed to mitigate cardiovascular disease risk in this population; a multimodal model such as cardiac rehabilitation may be a potential solution. This statement from the American Heart Association provides an overview of the existing knowledge and rationale for the use of cardiac rehabilitation to provide structured exercise and ancillary services to cancer patients and survivors. This document introduces the concept of cardio-oncology rehabilitation, which includes identification of patients with cancer at high risk for cardiac dysfunction and a description of the cardiac rehabilitation infrastructure needed to address the unique exposures and complications related to cancer care. In this statement, we also discuss the need for future research to fully implement a multimodal model of cardiac rehabilitation for patients with cancer and to determine whether reimbursement of these services is clinically warranted.


Assuntos
Sobreviventes de Câncer , Reabilitação Cardíaca/normas , Cardiologia/normas , Doenças Cardiovasculares/terapia , Oncologia/normas , Neoplasias/terapia , American Heart Association , Cardiotoxicidade , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Consenso , Feminino , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/mortalidade , Neoplasias/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Estados Unidos
18.
Rehabil Nurs ; 44(2): 115-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30830885

RESUMO

PURPOSE: This study examined temporal patterns in causal attributions generated by patients with cardiovascular disease before and after cardiac rehabilitation (CR). DESIGN: Qualitative, descriptive survey. METHODS: Eighty-six participants were asked what they believed was the primary cause of their cardiac events. Cardiac attributions were collected at the beginning of CR, at the end of CR, and 15 months after baseline. FINDINGS: Content analyses showed that heredity and behavior were the most commonly generated causes. Most participants showed stability in attributions over time, although we found a trend for more participants endorsing behavioral attributions at the end of the study. CONCLUSIONS: Cardiac attributions remain relatively stable across time. CLINICAL RELEVANCE: Cardiac rehabilitation staff should approach patients differently, depending on their causal narratives. Some patients enter CR understanding that behavior played a causal role, whereas some do not. Encouraging appreciation of the importance of behavior in cardiovascular disease onset and recurrence is vital.


Assuntos
Reabilitação Cardíaca/normas , Doenças Cardiovasculares/psicologia , Narração , Adulto , Idoso , Idoso de 80 Anos ou mais , Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários
19.
BMC Health Serv Res ; 19(1): 102, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728028

RESUMO

BACKGROUND: The use of clinical quality registries as means for data driven improvement in healthcare seem promising. However, their use has been shown to be challenged by a number of aspects, and we suggest some may be related to poor implementation. There is a paucity of literature regarding barriers and facilitators for registry implementation, in particular aspects related to data collection and entry. We aimed to illuminate this by exploring how staff perceive the implementation process related to the registries within the field of cardiac rehabilitation in England and Denmark. METHODS: A qualitative, interview-based study with staff involved in collecting and/or entering data into the two case registries (England N = 12, Denmark N = 12). Interviews were analysed using content analysis. The Consolidated Framework for Implementation Research was used to guide interviews and the interpretation of results. RESULTS: The analysis identified both similarities and differences within and between the studied registries, and resulted in clarification of staffs´ experiences in an overarching theme: ´Struggling with practices´ and five categories; the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context. Overall, implementation received little focused attention. There was a lack of active support from management, and staff may experience a struggle of fitting use of a registry into a busy and complex everyday practice. CONCLUSION: The study highlights factors that may be important to consider when planning and implementing a new clinical quality registry within the field of cardiac rehabilitation, and is possibly transferrable to other fields. The results may thus be useful for policy makers, administrators and managers within the field and beyond. Targeting barriers and utilizing knowledge of facilitating factors is vital in order to improve the process of registry implementation, hence helping to achieve the intended improvement of care processes and outcomes.


Assuntos
Reabilitação Cardíaca/normas , Assistência à Saúde/normas , Melhoria de Qualidade/organização & administração , Pessoal Administrativo , Confiabilidade dos Dados , Coleta de Dados , Dinamarca , Inglaterra , Feminino , Recursos em Saúde/normas , Humanos , Masculino , Pesquisa Qualitativa , Sistema de Registros/normas
20.
J Cardiopulm Rehabil Prev ; 39(4): 226-234, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30720641

RESUMO

PURPOSE: Despite evidence of the effectiveness of cardiac rehabilitation (CR), there is wide variability in programs, which may impact their quality. The objectives of this review were to (1) evaluate the ways in which we measure CR quality internationally; (2) summarize what we know about CR quality and quality improvement; and (3) recommend potential ways to improve quality. METHODS: For this narrative review, the literature was searched for CR quality indicators (QIs) available internationally and experts were also consulted. For the second objective, literature on CR quality was reviewed and data on available QIs were obtained from the Canadian Cardiac Rehabilitation Registry (CCRR). For the last objective, literature on health care quality improvement strategies that might apply in CR settings was reviewed. RESULTS: CR QIs have been developed by American, Canadian, European, Australian, and Japanese CR associations. CR quality has only been audited across the United Kingdom, the Netherlands, and Canada. Twenty-seven QIs are assessed in the CCRR. CR quality was high for the following indicators: promoting physical activity post-program, assessing blood pressure, and communicating with primary care. Areas of low quality included provision of stress management, smoking cessation, incorporating the recommended elements in discharge summaries, and assessment of blood glucose. Recommended approaches to improve quality include patient and provider education, reminder systems, organizational change, and advocacy for improved CR reimbursement. An audit and feedback strategy alone is not successful. CONCLUSIONS: Although not a lot is known about CR quality, gaps were identified. The quality improvement initiatives recommended herein require testing to ascertain whether quality can be improved.


Assuntos
Reabilitação Cardíaca , Melhoria de Qualidade/organização & administração , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/normas , Humanos , Internacionalidade , Lacunas da Prática Profissional
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