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Rasmussen B, Maribo T, Skovsby Toft B. The content and characteristics of face-to-face interventions to encourage patients' enrollment in cardiac rehabilitation; a scoping review. Disabil Rehabil 2024; 46:2734-2746. [PMID: 37480155 DOI: 10.1080/09638288.2023.2236014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To provide an overview of the content and characteristics of face-to-face interventions to encourage enrollment in exercise-based cardiac rehabilitation (CR). METHODS Following a published protocol describing the methods, six databases were searched. The search was limited to studies published from January 2000 to December 2021. Two reviewers independently performed study selection and data extraction. RESULTS 5583 studies were identified and 20 studies with a variety of study designs met the inclusion criteria. Eight studies specified important content in face-to-face interventions to be: Education, problem-solving, support of autonomy, exploring reasons for change, emotional and cognitive support while showing understanding. Studies targeting patients' experiences used motivational interviewing and addressed worries and anticipated difficulties. Intention to attend, CR barriers, practical barriers, exercise self-efficacy, and patients asking questions supported enrollment. Reassurance could lead to nonattendance if patients had a high degree of worry and distress. CONCLUSION Face-to-face interventions are important to support patients' enrollment in CR and should integrate a person-centered dialogue exploring reasons for change and providing support to overcome barriers. Focus on the patients' perspectives, the mechanisms of change, and the evaluation of the intervention to inform implementation should be further explored.Implications for RehabilitationIn-hospital face-to-face interventions support enrollment in cardiac rehabilitation (CR) in patients with ischemic heart disease.This study suggests that individual worries and barriers toward CR should be jointly explored while considering patients' capacity for making choices as well as their vulnerability.Patients should be encouraged to ask questions.A too strong focus on reassurance and problem-solving can impede enrollment.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio- and Occupational Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Aarhus, Denmark
| | - Bente Skovsby Toft
- Research Centre for Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
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Pinero de Plaza MA, Gebremichael L, Brown S, Wu CJ, Clark RA, McBride K, Hines S, Pearson O, Morey K. Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease. Int J Integr Care 2023; 23:17. [PMID: 38107834 PMCID: PMC10723014 DOI: 10.5334/ijic.7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). Methods A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Results Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. Discussion The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Conclusions Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.
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Affiliation(s)
- Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Lemlem Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | | | - Chiung-Jung Wu
- School of Health, University of the Sunshine Coast, Petrie, QLD, 4502, AU
- Royal Brisbane & Women’s Hospital, QLD, 4029, AU
| | - Robyn A. Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5000, AU
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
| | - Katharine McBride
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Telethon Kids Institute, Adelaide, SA, 5000, AU
- The John Curtin School of Medical Research, The Australian National University, Acton, ACT 2601, AU
| | - Sonia Hines
- The Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence. Alice Springs, NT, 0871, AU
- Flinders University, Rural and Remote Health, Alice Springs, Northern Territory, 0871, AU
| | - Odette Pearson
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
- Adelaide Medical School, The University of Adelaide, SA, 5000, AU
| | - Kim Morey
- South Australian Aboriginal Chronic Disease Consortium, Adelaide, SA, 5001, AU
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, AU
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Ganie Z, Soeker MS. A qualitative enquiry regarding the factors influencing return to work after a cardiac incident in the Western Cape, South Africa. Work 2023:WOR220065. [PMID: 36641722 DOI: 10.3233/wor-220065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programs have been documented to improve functional abilities, however further research is required with regard to activity limitation, participation restrictions, facilitators, and barriers of return to work, after cardiac rehabilitation. OBJECTIVE This qualitative study aimed to determine and explore the barriers and enablers of return to work for individuals with cardiovascular disease who completed a cardiac rehabilitation program in the Western Cape, South Africa. The qualitative exploration was part of a study that resulted in a return-to-work program for individuals with cardiac disease. METHOD Qualitative methodology was employed for this study. Semi-structured interviews were used with 10 participants that attended a cardiac rehabilitation program. Thematic analysis of the qualitative data was completed. RESULTS The participants described the barriers and facilitators of their return-to-work process and the factors that were of critical importance in the resumption of the worker role or the result of unemployment. The four major themes were 1) Cardiac conditions negatively affect function, 2) Being unemployed, 3) Participation in ADLs and lifestyle modification enhances one's activity levels, and 4) Return to work. CONCLUSION Lifestyle modification and reasonable accommodation enable a successful return to work after a cardiac incident.
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Affiliation(s)
- Zakeera Ganie
- Occupational Therapy Department, University of The Western Cape, Cape Town, South Africa
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Asghar I, Egaji OA, Griffiths M. An overview of the digital solutions for helping people with aphasia through bibliometric analysis. eNeurologicalSci 2021; 22:100311. [PMID: 33490656 PMCID: PMC7807248 DOI: 10.1016/j.ensci.2021.100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/31/2020] [Indexed: 01/02/2023] Open
Abstract
This paper gives insights into recent research developments in the field of digital solutions for people with aphasia and tries to analyse its impact on their rehabilitation. A bibliometric research approach is used for data collection. Relevant studies were extracted from seven major academic databases from years 2000 to 2019 inclusive. The systematic process resulted in 986 studies. The average growth in this field is 4%, which is less compared to other research areas. However, the average citations per paper is 7.27, which represents a medium level of publication quality. Scopus and Web of Science are leading databases for the number of studies (379 and 264) and quality of publications (P-Index: 49.26 and 32.85), respectively. The USA, with 42% of publications, leads this research field, followed by the UK with 15%. Both countries have national aphasia strategies in place through charities (not government level strategies), which potentially contributed to their research leadership. The results show that recent advances in digital solutions have the potential to support people with aphasia. However, further work is needed at both academic and government levels to deliver more research contributions and funding for the rehabilitation of people with aphasia. The countries with clear national aphasia strategies in place lead this research field. Western countries carry most of the research for aphasia; the global view of this research area is still messing. Personal care, in combination with digital solutions, can yield better results. The fully immersive virtual reality solutions offer close to real-life interaction experience for the people with aphasia and their surroundings inside the virtual space.
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Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke: PSYCHOLOGICAL PROFILE AND OUTCOMES. J Cardiopulm Rehabil Prev 2018; 37:428-436. [PMID: 28727668 DOI: 10.1097/hcr.0000000000000274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Having previously reported that comprehensive cardiac rehabilitation (CCR) is effective for secondary prevention post-transient ischemic attack (TIA)/mild nondisabling stroke (MNDS), we present psychometric findings for the same sample that elucidate subacute TIA/MNDS psychological outcomes and test whether CCR would be independently associated with psychological improvements. METHODS In this prospective cohort trial patients with ≥1 risk factor, recruited from a stroke prevention clinic within 12 months (mean = 11.5 weeks) post-TIA/MNDS, entered CCR. RESULTS Of the 110 recruited patients, 100 (mean age = 65.4 years; 46 females) entered CCR and 80 completed CCR (mean duration = 7.6 months). At CCR entry, 16.5% and 39.2% screened positively for depression and anxiety, decreasing nonsignificantly at exit to 4.2%, and significantly to 16.9% (P = .008), respectively. Age-corrected deficits occurred more frequently than expected (P ≤ .03); at entry, mental health status (13.3%), clock-drawing (31.6%), oral-verbal fluency (16.9%), word-list learning (11.2%), and recall (12.6%); at exit, clock-drawing (30.0%). Entry-to-exit, mean depression, anxiety, mental and physical health status, word-list learning, memory, digit-symbol coding, and oral-verbal fluency scores improved significantly (P ≤ .031). No reliable change indices were significant. Psychological service recipients improved significantly more than nonrecipients in depression (P = .049). Baseline North American Adult Reading Test score predicted exercise attendance (R = 0.275; P = .044); New York Heart Association (NYHA) class and depression score predicted exit physical health status (R = 0.770, P < .001); and depression score predicted exit mental health status (R = 0.523, P < .001). CONCLUSIONS Anxiety and executive dysfunction persisted post-TIA/MNDS. Although promising for secondary prevention post-TIA/MNDS, CCR was not independently associated with psychological improvements. CCR psychological treatment may benefit depression. Subacute NYHA class and depression may later affect quality of life.
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Prevention of Cardiovascular Disease Among Cancer Survivors: the Role of Pre-existing Risk Factors and Cancer Treatments. CURR EPIDEMIOL REP 2017. [DOI: 10.1007/s40471-017-0117-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kim C, Choi HE, Lim YJ. The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction. Ann Rehabil Med 2016; 40:647-56. [PMID: 27606271 PMCID: PMC5012976 DOI: 10.5535/arm.2016.40.4.647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/20/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF. METHODS Patients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%-49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%-85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program. RESULTS After completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO2max. In the pLVEF group, LVEF and VO2max increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO2max increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely. CONCLUSION In both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hee Eun Choi
- Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Joon Lim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Marzolini S, Blanchard C, Alter DA, Grace SL, Oh PI. Delays in Referral and Enrolment Are Associated With Mitigated Benefits of Cardiac Rehabilitation After Coronary Artery Bypass Surgery. Circ Cardiovasc Qual Outcomes 2015; 8:608-20. [DOI: 10.1161/circoutcomes.115.001751] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Susan Marzolini
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Chris Blanchard
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - David A. Alter
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Sherry L. Grace
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
| | - Paul I. Oh
- From the Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada (S.M., D.L.A., S.L.G., P.I.O.); Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (C.B.); and Faculty of Health, York University, Toronto, Ontario, Canada (S.G.)
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de Vries H, Kemps HM, van Engen-Verheul MM, Kraaijenhagen RA, Peek N. Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients. Eur Heart J 2015; 36:1519-28. [DOI: 10.1093/eurheartj/ehv111] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/17/2015] [Indexed: 01/20/2023] Open
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Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, Ignaszewski A. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:952-9. [PMID: 25271050 DOI: 10.1161/circoutcomes.114.001230] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott A Lear
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.).
| | - Joel Singer
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Davina Banner-Lukaris
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Dan Horvat
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Julie E Park
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Joanna Bates
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Andrew Ignaszewski
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
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van der Klauw D, Molema H, Grooten L, Vrijhoef H. Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review. Int J Integr Care 2014; 14:e024. [PMID: 25114665 PMCID: PMC4109400 DOI: 10.5334/ijic.1127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/31/2014] [Accepted: 05/08/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives. THEORY AND METHODS Existing models often present a large variety of dimensions, archetypes and categories of integration without specifying them. Models and programmes describing integrated care for chronic diseases were reviewed. Data were extracted related to objectives and clusters of mechanisms of integration. RESULTS Thirty-four studies presented four objectives: functional, organisational, professional and service integration. We categorised approaches and interventions to achieve these objectives by strategy and clusters of 'mechanisms of integration': degree, patient centredness and normative aspects. CONCLUSIONS AND DISCUSSION The clarification of mechanisms to achieve objectives of integrated care as presented may be used as starting point for the development and refinement of integrated care programmes, including methodological grounding of their evaluation. Given that most studies reviewed lack both empirical data and descriptions of the methods used, future research needs to close these gaps. Validation of the findings by a large panel of experts is suggested as recommendation to work towards a grounded framework.
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Affiliation(s)
| | | | | | - Hubertus Vrijhoef
- MD3, National University of Singapore, 16 Medical Drive, 117597 Singapore
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Abstract
PURPOSE Despite well-documented positive benefits, cardiac rehabilitation (CR) is an underutilized resource for patients following a cardiac event or intervention. Bias in the CR referral process has led to programs designed to ensure that all eligible patients receive a referral. The purpose of the current investigation was to describe the implementation of a nurse-delivered automatic bedside referral process and to examine the effectiveness on referral and intake rates for CR. METHODS In 2007, an automatic CR referral system was implemented at the University of Ottawa Heart Institute. A nurse-delivered automatic bedside referral process was implemented in 2008. A CR nurse screened all inpatient charts, discussed CR benefits and program options with patients, triaged the patient to the appropriate program, and facilitated booking of the CR intake appointment. Data were analyzed to determine the effectiveness of this approach. RESULTS Only 15.5% to 19.7% of eligible patients participated in CR program prior to 2006. Implementation of an automatic referral process increased participation to 26.7%. The nurse-delivered bedside automatic referral process increased participation to 32.6%. The proportion of patients receiving CR referrals almost tripled following the implementation of the nurse-delivered referral process from 26.7% in 2003 to 79.0% in 2008. CONCLUSIONS A nurse-delivered automatic bedside referral process had a positive impact on both referral and intake to CR. Future challenges for CR programs will be to ensure optimal participation in programs, while managing the growth associated with increased rates of involvement.
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Tobe SW, Poirier L, Tremblay G, Lindsay P, Reid D, Campbell NRC, Khan N, Quinn RR, Rabi D. Challenges and scientific considerations in hypertension management reflected in the 2012 recommendations of the Canadian Hypertension Education Program. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2012; 6:e127-33. [PMID: 23687527 PMCID: PMC3654508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 12/05/2022]
Abstract
This article provides the scientific rationale and background information for the Canadian Hypertension Education Program's 2012 recommendations for the management of hypertension. It also summarizes the key new recommendations and the theme for 2012, which is the prevention of hypertension. The full recommendations are available at www.hypertension.ca.
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Martin BJ, Hauer T, Arena R, Austford LD, Galbraith PD, Lewin AM, Knudtson ML, Ghali WA, Stone JA, Aggarwal SG. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation 2012; 126:677-87. [PMID: 22777176 DOI: 10.1161/circulationaha.111.066738] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an efficacious yet underused treatment for patients with coronary artery disease. The objective of this study was to determine the association between CR completion and mortality and resource use. METHODS AND RESULTS We conducted a prospective cohort study of 5886 subjects (20.8% female; mean age, 60.6 years) who had undergone angiography and were referred for CR in Calgary, AB, Canada, between 1996 and 2009. Outcomes of interest included freedom from emergency room visits, hospitalization, and survival in CR completers versus noncompleters, adjusted for clinical covariates, treatment strategy, and coronary anatomy. Hazard ratios for events for CR completers versus noncompleters were also constructed. A propensity model was used to match completers to noncompleters on baseline characteristics, and each outcome was compared between propensity-matched groups. Of the subjects referred for CR, 2900 (49.3%) completed the program, and an additional 554 subjects started but did not complete CR. CR completion was associated with a lower risk of death, with an adjusted hazard ratio of 0.59 (95% confidence interval, 0.49-0.70). CR completion was also associated with a decreased risk of all-cause hospitalization (adjusted hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) and cardiac hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.55-0.83) but not with emergency room visits. Propensity-matched analysis demonstrated a persistent association between CR completion and reduced mortality. CONCLUSIONS Among those coronary artery disease patients referred, CR completion is associated with improved survival and decreased hospitalization. There is a need to explore reasons for nonattendance and to test interventions to improve attendance after referral.
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Affiliation(s)
- Billie-Jean Martin
- Libin Cardiovascular Institute, Room C849, 8th Floor Cardiology, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
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Randomized controlled trial of tailored nursing interventions to improve cardiac rehabilitation enrollment. Nurs Res 2012; 61:111-20. [PMID: 22282154 DOI: 10.1097/nnr.0b013e318240dc6b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Short hospital stays for patients with acute coronary syndromes (ACSs) reduce the opportunity for risk factor intervention during admission. After discharge, cardiac rehabilitation can decrease the recurrence of coronary events by up to 25%. However, it remains underused. OBJECTIVES The aim of this study was to determine whether a nursing intervention focused on individual ACS patients' perceptions of their disease and treatment would increase rehabilitation enrollment after discharge. METHOD A total of 242 ACS patients admitted to a specialized tertiary cardiac center were randomized to either the intervention or usual care (n = 121 in both groups). The intervention included one nurse-patient meeting before discharge with 2 additional contacts over the 10 days after discharge (mean duration = 40 minutes per contact). The primary outcome was enrollment in a free rehabilitation program offered to all participants 6 weeks after discharge. Secondary outcomes included illness perceptions; family support; anxiety level; medication adherence; and cardiac risk factors including lack of exercise, smoking, body mass index, and diet. RESULTS The sample was composed of a majority of male, married workers who experienced a myocardial infarction or unstable angina without severe complications. The mean hospital stay in both groups was 3.6 days. There was a significantly higher rate of rehabilitation enrollment in the intervention group (45%) than in the control group (24%; p = .001). For the secondary outcomes, only the personal control dimension of illness perceptions was improved significantly with the intervention. DISCUSSION Progressive, individualized interventions by nurses resulted in greater rehabilitation enrollment, thereby potentially improving long-term outcome.
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Pituskin E, Paterson I, Haykowsky M. The Role of Exercise Interventions in Reducing the Risk for Cardiometabolic Disease in Cancer Survivors. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arthur HM, Campbell P, Harvey PJ, McGillion M, Oh P, Woodburn E, Hodgson C. Women, cardiac syndrome X, and microvascular heart disease. Can J Cardiol 2012; 28:S42-9. [PMID: 22424283 DOI: 10.1016/j.cjca.2011.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 02/07/2023] Open
Abstract
New data suggest that persistent chest pain, despite normal coronary angiography, is less benign than previously thought. It has long been recognized that cardiac syndrome X (CSX) is associated with significant suffering, disability, and health care costs, but the biggest shift in thinking comes in terms of long-term risk. It is now recognized that the prognosis is not benign and that a significant proportion of patients are at increased cardiovascular disease risk. Of major debate is the question of whether the mechanisms that explain this chest pain are cardiac vs noncardiac. The most current definition of CSX is the triad of angina, ischemia, and normal coronary arteries, which is associated with an increased cardiovascular risk. This paper provides a review of CSX, epidemiology of the problem, proposed explanatory mechanisms, and important next steps in research. Central to this review is the proposition that new insights into CSX will be fostered by both clinical and scientific collaboration between cardiovascular and pain scientists.
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Affiliation(s)
- Heather M Arthur
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Effectiveness of a Pedometer-Based Program Using a Socio-cognitive Intervention on Physical Activity and Quality of Life in a Setting of Cardiac Rehabilitation. Can J Cardiol 2012; 28:27-32. [DOI: 10.1016/j.cjca.2011.09.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 09/28/2011] [Accepted: 09/28/2011] [Indexed: 11/19/2022] Open
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Grace SL, Chessex C, Arthur H, Chan S, Cyr C, Dafoe W, Juneau M, Oh P, Suskin N. Systematizing Inpatient Referral to Cardiac Rehabilitation 2010: Canadian association of cardiac rehabilitation and Canadian cardiovascular society joint position paper. J Cardiopulm Rehabil Prev 2011; 31:E1-8. [PMID: 21460733 DOI: 10.1097/hcr.0b013e318219721f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite recommendations in clinical practice guidelines, evidence suggests cardiac rehabilitation (CR) referral and use following indicated cardiac events is low. Referral strategies such as systematic referral have been advocated to improve CR use. The objective of this policy position is to synthesize evidence and make recommendations on strategies to increase patient enrollment in CR. A systematic review of 6 databases from inception to January 2009 was conducted. Only primary, published, English-language studies were included. A meta-analysis was undertaken to synthesize the enrollment rates by referral strategy. In all, 14 studies met inclusion criteria. Referral strategies were categorized as systematic on the basis of use of systematic discharge order sets, as liaison on the basis of discussions with allied health care providers, or as other on the basis of patient letters. Overall, there were 7 positive studies, 5 without comparison groups, and 2 studies that reported null findings. The combined effect sizes of the meta-analysis were as follows: 73% (95% CI, 39%-92%) for the patient letters ("other"), 66% (95% CI, 54%-77%) for the combined systematic and liaison strategy, 45% (95% CI, 33%-57%) for the systematic strategy alone, and 44% (95% CI, 35%-53%) for the liaison strategy alone. In conclusion, the results suggest that innovative referral strategies increase CR use. Although patient letters look promising, evidence for this strategy is sparse and inconsistent at present. Therefore we suggest that inpatient units adopt systematic referral strategies, including a discussion at the bedside, for eligible patient groups in order to increase CR enrollment and participation. This approach should be considered best practice for further investigation.
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Parker K, Stone JA, Arena R, Lundberg D, Aggarwal S, Goodhart D, Traboulsi M. An Early Cardiac Access Clinic Significantly Improves Cardiac Rehabilitation Participation and Completion Rates in Low-Risk ST-Elevation Myocardial Infarction Patients. Can J Cardiol 2011; 27:619-27. [DOI: 10.1016/j.cjca.2010.12.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Grace SL, Chessex C, Arthur H, Chan S, Cyr C, Dafoe W, Juneau M, Oh P, Suskin N. Systematizing inpatient referral to cardiac rehabilitation 2010: Canadian Association of Cardiac Rehabilitation and Canadian Cardiovascular Society joint position paper endorsed by the Cardiac Care Network of Ontario. Can J Cardiol 2011; 27:192-9. [PMID: 21459268 DOI: 10.1016/j.cjca.2010.12.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/07/2010] [Accepted: 12/07/2010] [Indexed: 02/07/2023] Open
Abstract
Despite recommendations in clinical practice guidelines, evidence suggests cardiac rehabilitation (CR) referral and use following indicated cardiac events is low. Referral strategies such as systematic referral have been advocated to improve CR use. The objective of this policy position is to synthesize evidence and make recommendations on strategies to increase patient enrollment in CR. A systematic review of 6 databases from inception to January 2009 was conducted. Only primary, published, English-language studies were included. A meta-analysis was undertaken to synthesize the enrollment rates by referral strategy. In all, 14 studies met inclusion criteria. Referral strategies were categorized as systematic on the basis of use of systematic discharge order sets, as liaison on the basis of discussions with allied health care providers, or as other on the basis of patient letters. Overall, there were 7 positive studies, 5 without comparison groups, and 2 studies that reported null findings. The combined effect sizes of the meta-analysis were as follows: 73% (95% CI, 39%-92%) for the patient letters ("other"), 66% (95% CI, 54%-77%) for the combined systematic and liaison strategy, 45% (95% CI, 33%-57%) for the systematic strategy alone, and 44% (95% CI, 35%-53%) for the liaison strategy alone. In conclusion, the results suggest that innovative referral strategies increase CR use. Although patient letters look promising, evidence for this strategy is sparse and inconsistent at present. Therefore we suggest that inpatient units adopt systematic referral strategies, including a discussion at the bedside, for eligible patient groups in order to increase CR enrollment and participation. This approach should be considered best practice for further investigation.
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Affiliation(s)
- Sherry L Grace
- York University and University Health Network, Toronto, Ontario, Canada
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McKelvie RS, Moe GW, Cheung A, Costigan J, Ducharme A, Estrella-Holder E, Ezekowitz JA, Floras J, Giannetti N, Grzeslo A, Harkness K, Heckman GA, Howlett JG, Kouz S, Leblanc K, Mann E, O'Meara E, Rajda M, Rao V, Simon J, Swiggum E, Zieroth S, Arnold JMO, Ashton T, D'Astous M, Dorian P, Haddad H, Isaac DL, Leblanc MH, Liu P, Sussex B, Ross HJ. The 2011 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Sleep Apnea, Renal Dysfunction, Mechanical Circulatory Support, and Palliative Care. Can J Cardiol 2011; 27:319-38. [DOI: 10.1016/j.cjca.2011.03.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022] Open
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O'Neill BJ, Simpson CS. Improved wait times for coronary revascularization: cause to celebrate spotting the iceberg in time or time to look under the surface? Can J Cardiol 2011; 27:263.e1-3. [PMID: 21459279 DOI: 10.1016/j.cjca.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 01/02/2011] [Indexed: 10/18/2022] Open
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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