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Gadager BB, Tang LH, Doherty P, Svendsen ML, Sibilitz KL, Harrison A, Maribo T. Are cardiac rehabilitation pathways influenced by diabetes: A cohort study. Int J Cardiol 2024; 411:132275. [PMID: 38880427 DOI: 10.1016/j.ijcard.2024.132275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of these patients in CR has been less studied. This study examines the referral, uptake, and completion rates in the CR pathway for ACS patients with and without diabetes to identify potential barriers in the CR pathway. METHODS The study included patients aged 18 or above who were discharged after a diagnosis of ACS in the Central Denmark Region between 1 September 2017 and 31 August 2018. Diabetes information was obtained from three sources. Logistic regression models were used to examine the associations between having diabetes and the three outcomes: non-referral, non-uptake and non-completion. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS A total of 2447 patients were eligible for the study, of which 457 (18.7%) had diabetes. Only non-uptake was found to be significantly associated with diabetes after adjustment for prespecified variables (OR = 1.38, 95% CI 1.01-1.90). Associations for non-referral (OR = 1.11, 95% CI 0.87-1.41) and non-completion (OR = 1.06, 95 %CI 0.73-1.53) were not found to be statistically significant between ACS patients with diabetes and those without diabetes. CONCLUSION This study highlights a significant disparity in the uptake of CR between patients with and without diabetes following ACS, demonstrating that patients with diabetes require early promotion and increased assistance to enrol in CR.
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Affiliation(s)
- Birgitte Bitsch Gadager
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Lars Hermann Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | | | | | - Thomas Maribo
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
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Ravn MB, Berthelsen C, Maribo T, Nielsen CV, Pedersen CG, Handberg C. Opting out of cardiac rehabilitation in local community healthcare services: Patients' perspectives and reflections. J Eval Clin Pract 2024; 30:1039-1048. [PMID: 38798172 DOI: 10.1111/jep.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/05/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
RATIONALE Despite cardiac rehabilitation and medical treatment being integrated parts of the pathway of patients with cardiovascular disease, as well as the well-establish positive effect, cardiac rehabilitation remains underutilised. In recent years, cardiac rehabilitation has increasingly been moved from the hospitals to the community healthcare services. This transition may be challenging for patients with cardiovascular disease. AIM To investigate reflections and perspectives of patients opting out of cardiac rehabilitation in community healthcare services to improve participation and adherence to cardiac rehabilitation in the future. RESULTS A total of eight patients opting out of cardiac rehabilitation participated in individual interviews. Opting out of cardiac rehabilitation is defined as never enroled or did not complete cardiac rehabilitation. The Interpretive Description methodology was used in the analysis where two themes and six subthemes were identified: (1) 'Structural and organisational factors' with three subthemes; Being a patient in the healthcare system, Enroling into CR when it is meaningful, and Getting back to work is vital, and (2) 'Patients' internal factors' with three subthemes; Feeling a desire to regain control, Seeing yourself as recovered, and Being aware of own needs. The analysis indicates that patients' decision to opt out of CR was multidimensional and based on a combination of factors. CONCLUSION Ensuring that the healthcare professionals in the community have sufficient information regarding the patient and a clear communication plan between the healthcare professionals and the patient may reduce the transition causing confusion and frustrations for patients. Incorporating a vocational element in CR and ensuring that employers understand the importance of CR may hamper returning to work as a challenge to CR. Ensuring timely CR referral and enrolment and a transition coordinator may reduce the challenge of patients not viewing CR as meaningful. However, further studies are needed to fully understand how CR could become meaningful for patients opting out of CR.
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Affiliation(s)
- Maiken Bay Ravn
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Connie Berthelsen
- Zealand University Hospital, Roskilde and Køge, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Social Medicine and Rehabilitation, Region Hospital Goedstrup, Denmark
| | - Charlotte G Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Wittboldt S, Leosdottir M, Ravn Fischer A, Ekman B, Bäck M. Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden - standards, costs, and adherence to European guidelines (The Perfect-CR study). Physiother Theory Pract 2024; 40:366-376. [PMID: 36047009 DOI: 10.1080/09593985.2022.2114052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
AIMS Information on standards including structure- and process-based metrics and how exercise-based cardiac rehabilitation (EBCR) is delivered in relation to guidelines is lacking. The aims of the study were to evaluate standards and adherence to guidelines at Swedish CR centers and to conduct a cost analysis of the physiotherapy-related activities of EBCR. METHODS AND RESULTS EBCR standards at all 78 CR centers in Sweden in 2016 were surveyed. The questions were based on guideline-recommended core components of EBCR for patients after a myocardial infarction (MI). The cost analysis included the identification, quantification, and valuation of EBCR-related cost items. Patients were offered a pre-discharge consultation with a physiotherapist at n = 61, 78% of the centers. A pre-exercise screening visit was routinely offered at n = 64, 82% of the centers, at which a test of aerobic capacity was offered in n = 58, 91% of cases, most often as a cycle ergometer exercise test n = 55, 86%. A post-exercise assessment was offered at n = 44, 56% of the centers, with a functional test performed at n = 30, 68%. Almost all the centers n = 76, 97% offered supervised EBCR programs. The total cost of delivering physiotherapy-related activities of EBCR according to guidelines was approximately 437 euro (4,371 SEK) per patient. Delivering EBCR to one MI patient required 11.25 hours of physiotherapy time. CONCLUSION While the overall quality of EBCR programs in Sweden is high, there are several areas of potential improvement to reach the recommended European standards across all centers. To improve the quality of EBCR, further compliance with guidelines is warranted.
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Affiliation(s)
- Susanna Wittboldt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Annica Ravn Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
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Sadeghi M, Rafatifard M, Hadavi M, Drostkar N, Naderi M, Azizian S, Zamani S, Yazdekhasti S, Azizi E, Rahban H, Roohafza H, Shokri K. Outpatient Cardiovascular Rehabilitation Registry in Iran: The First Rehabilitation Registry Experience at EMR. ARYA ATHEROSCLEROSIS 2023; 19:9-17. [PMID: 38882644 PMCID: PMC11178996 DOI: 10.48305/arya.2023.41410.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/04/2023] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The collected information includes demographic profile, medical history, physical examination, patient risk factors, anthropometric evaluation, medications, echocardiographic results, and exercise testing of all patients who participated in the outpatient cardiac rehabilitation program in Cardiac Rehabilitation Department since 1996 until now. Each patient was assigned an electronic code by which the patient's information could be identified. Subsequently, standard questionnaires were used, such as International physical activity questionnaire (IPAQ) to assess physical activity, MAC NEW to assess the quality of life, Spielberg to measure anxiety, Beck to assess depression, and nutritional questionnaires. RESULTS The findings were recorded, and the data were analyzed by the web and SPSS software. For all patients, the forms were filled based on a number of variables including backgrounds, registration components, type of referral, diagnosis of underlying heart disease, methods of data collection and entry, details of the educational program, return to work, psychiatric condition, drug regimen, clinical condition, echocardiography findings, functional capacity and exercise test response, smoking status, nutritional habits, and finally their 5-year follow-up for events and re-hospitalization. CONCLUSION It is necessary for the authors to establish a cardiac rehabilitation registration that can properly display care quality indicators and collect and report standard data from different nations to improve the quality of cardiac rehabilitation services and identify weaknesses.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Rafatifard
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Health Science/ Exercise Physiology, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammadmahdi Hadavi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Drostkar
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Naderi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sana Azizian
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Zamani
- Department of Cardiology, Chamran Cardiovascular and Medical Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Yazdekhasti
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Azizi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Habib Rahban
- Physician Research Associate, Cardiovascular Research Foundation of Southern California, Southern California Medical Education Consortium, Universal Health System, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kasra Shokri
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Leosdottir M, Hagstrom E, Hadziosmanovic N, Norhammar A, Lindahl B, Hambraeus K, Jernberg T, Bäck M. Temporal trends in cardiovascular risk factors, lifestyle and secondary preventive medication for patients with myocardial infarction attending cardiac rehabilitation in Sweden 2006-2019: a registry-based cohort study. BMJ Open 2023; 13:e069770. [PMID: 37173109 DOI: 10.1136/bmjopen-2022-069770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Registries have been highlighted as means to improve quality of care. Here, we describe temporal trends in risk factors, lifestyle and preventive medication for patients after myocardial infarction (MI) registered in the quality registry Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). DESIGN A registry-based cohort study. SETTING All coronary care units and cardiac rehabilitation (CR) centres in Sweden. PARTICIPANTS Patients attending a CR visit at 1-year post-MI 2006-2019 were included (n=81 363, 18-74 years, 74.7% men). OUTCOME MEASURES Outcome measures at 1-year follow-up included blood pressure (BP) <140/90 mm Hg, low-density lipoprotein-cholesterol (LDL-C)<1.8 mmol/L, persistent smoking, overweight/obesity, central obesity, diabetes prevalence, inadequate physical activity, and prescription of secondary preventive medication. Descriptive statistics and testing for trends were applied. RESULTS The proportion of patients attaining the targets for BP<140/90 mmHg increased from 65.2% (2006) to 86.0% (2019), and LDL-C<1.8 mmol/L from 29.8% (2006) to 66.9% (2019, p<0.0001 both). While smoking at the time of MI decreased (32.0% to 26.5%, p<0.0001), persistent smoking at 1 year was unchanged (42.8% to 43.2%, p=0.672) as was the prevalence of overweight/obesity (71.9% to 72.9%, p=0.559). Central obesity (50.5% to 57.0%), diabetes (18.2% to 27.2%) and patients reporting inadequate levels of physical activity (57.0% to 61.5%) increased (p<0.0001 for all). From 2007, >90.0% of patients were prescribed statins and approximately 98% antiplatelet and/or anticoagulant therapy. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription increased from 68.7% (2006) to 80.2% (2019, p<0.0001). CONCLUSIONS While little change was observed for persistent smoking and overweight/obesity, large improvements were observed for LDL-C and BP target achievements and prescription of preventive medication for Swedish patients after MI 2006-2019. Compared with published results from patients with coronary artery disease in Europe during the same period, these improvements were considerably larger. Continuous auditing and open comparisons of CR outcomes might possibly explain some of the observed improvements and differences.
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Affiliation(s)
- Margret Leosdottir
- Department of Cardiology, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences Malmo, Lund University, Malmo, Sweden
| | - Emil Hagstrom
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Anna Norhammar
- Department of Medicine Solna, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
- Capio Sankt Gorans Sjukhus, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Maria Bäck
- Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping University, Linkoping, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Holdgaard A, Eckhardt-Hansen C, Lassen CF, Kjesbu IE, Dall CH, Michaelsen KL, Sibilitz KL, Prescott E, Rasmusen HK. Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial. Eur Heart J 2023; 44:986-996. [PMID: 36649937 DOI: 10.1093/eurheartj/ehac792] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. METHODS AND RESULTS In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. CONCLUSION Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.
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Affiliation(s)
- Annette Holdgaard
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christine Eckhardt-Hansen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Christina Funch Lassen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Ingunn Eklo Kjesbu
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christian Have Dall
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Kristine Lund Michaelsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hanne Kruuse Rasmusen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Pedersen SM, Kruse M, Zwisler ADO, Helmark C, Pedersen SS, Olsen KR. Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study. Scand J Public Health 2023; 51:179-187. [PMID: 34927492 DOI: 10.1177/14034948211062656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease. METHODS the study population consisted of 24,509 patients (18-70 years of age) discharged from an inpatient admission at a Danish hospital during 2014-2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20-I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation (N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population (N = 15,762). RESULTS Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77-0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97-1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02-1.15) and 12 months (OR 1.20, 95%CI: 1.13-1.28). CONCLUSIONS
Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work.
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Affiliation(s)
- Sasja Maria Pedersen
- DaCHE, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Marie Kruse
- DaCHE, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Ann Dorthe O Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Syddanmark, Denmark.,Knowledge centre for rehabilitation and palliative care, Odense University Hospital, Odense Denmark, University of Southern Denmark, Odense, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital.,Department of Psychology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Susanne S Pedersen
- Department of Cardiology, Odense University Hospital, Odense, Syddanmark, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Kim Rose Olsen
- DaCHE, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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8
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Kruse M, Laudicella M, Olsen KR, Zwisler ADO, Helmark C, Pedersen SS. Effects of screening for anxiety and depression in patients with ischaemic heart disease - a nationwide Danish register study. Scand J Public Health 2023; 51:149-156. [PMID: 35114856 DOI: 10.1177/14034948221074972] [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: 11/17/2022]
Abstract
AIM To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. METHODS We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015-2018 (N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. RESULTS Exposure to AD screening was lower for patients with low income (change in probability -0.67, 95% CI -0.76; -0.59), low education (change in probability -0.16, 95% CI -0.20; -0.13), and a high comorbidity burden (change in probability -0.09, 95% CI -0.10; -0.07). Screened patients had a lower conditional probability of AD treatment (change in probability -0.0061, p < 0.001) than non-screened patients. The patient's GP also had an impact on the probability of being referred for AD treatment. Using an instrumental variable approach did not affect the results. CONCLUSIONS
Screening for AD was subject to selection at the patient level; patients at lower risk of AD had a higher probability of being screened. Hence, extending systematic screening to cover a larger population may not achieve a noticeable increase in the uptake of AD treatment if it is not supported by appropriate measures to reduce reverse selection into screening.
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Affiliation(s)
- Marie Kruse
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mauro Laudicella
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ann Dorthe O Zwisler
- Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Denmark; University of Southern Denmark, Odense Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
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9
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Ravn MB, Berthelsen C, Maribo T, Nielsen CV, Pedersen CG, Handberg C. Understanding Facilitators and Challenges to Care Transition in Cardiac Rehabilitation: Perspectives and Assumptions of Healthcare Professionals. Glob Qual Nurs Res 2023; 10:23333936231217844. [PMID: 38107551 PMCID: PMC10722928 DOI: 10.1177/23333936231217844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease.
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Affiliation(s)
- Maiken Bay Ravn
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Connie Berthelsen
- Zealand University Hospital, Køge and Roskilde, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Thomas Maribo
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Aarhus University, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Region Hospital Goedstrup, Denmark
| | | | - Charlotte Handberg
- Aarhus University, Denmark
- National Rehabilitation Center for Neuromuscular Diseases; Aarhus, Denmark
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10
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Kjesbu I, Prescott E, Rasmusen H. K. H, Osler M, Larsen ML, Gustafsson I, Zwisler AD, Sibilitz KL. Socioeconomic and ethnical disparity in coronary heart disease outcomes in Denmark and the effect of cardiac rehabilitation—A nationwide registry study. PLoS One 2022; 17:e0276768. [PMCID: PMC9639811 DOI: 10.1371/journal.pone.0276768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Aims Cardiovascular patients with low socioeconomic status and non-western ethnic background have worse prognostic outcomes. The aim of this nationwide study was first to address whether short-term effects of hospital-based outpatient cardiac rehabilitation (CR) are similar across educational level and ethnic background, and secondly to study whether known disparity in long-term prognosis in patients with cardiovascular disese is diminished by CR participation. Methods All patients with myocardial infarction and/or coronary revascularization from August 2015 until March 2018 in the Danish national patient registry or the Danish cardiac rehabilitation database (DHRD) were included. We used descriptive statistics to address disparity in achievement of quality indicators in CR, and Cox proportional hazard regression to examine the association between the disparity measures and MACE (cardiovascular hospitalization and all-cause mortality) with adjustment for age, gender, index-diagnose and co-morbidity. Results We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR outcomes from the DHRD. We demonstrated a socioeconomic gradient in improvements in VO2peak, and non-western patients were less often screened for depression or receive dietary consulting. We found a strong socioeconomic gradient in MACE irrespective of CR participation, medication, and risk factor control (adjusted HR 0.65 (95% CI 0.56–0.77) for high versus low education). Non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1–1.4)). Conclusion We found only minor socioeconomic and ethnic differences in achievement of CR quality indicators but strong differences in CHD prognosis indication that conventional risk factor control and medical treatment following CR do not diminish the socioeconomic and ethnical disparity in CHD prognosis.
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Affiliation(s)
- Ingunn Kjesbu
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Hanne Rasmusen H. K.
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Merete Osler
- Centre for Clinical Research and Disease Prevention, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ida Gustafsson
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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11
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Egholm CL, Helmark C, Rossau HK, Munkehøj P, Brøndum S, Pedersen SS, Zwisler AD. Implementation of systematic screening for anxiety and depression in cardiac rehabilitation: Real world lessons from a longitudinal study. J Psychosom Res 2022; 158:110909. [PMID: 35472687 DOI: 10.1016/j.jpsychores.2022.110909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
AIMS Systematic screening for anxiety and depression is widely recommended as a core component of cardiac rehabilitation in ischemic heart disease, however, recommendation-practice gaps are common and limited knowledge exists about factors hindering and supporting implementation. The study aimed to assess adherence to national clinical guideline recommendations and to gain a greater understanding of the implementation of screening in real-world practice. METHODS An observational, longitudinal mixed-methods design including hospitals and municipalities in Denmark. We retrieved nationwide survey data from 2013, 2015, 2018 and 2021 to assess adherence to screening on programme level, and clinical quality registry data from 2016 to 2020 to assess proportion of patients screened. Data were analysed descriptively. Semi-structured interviews with healthcare professionals were conducted in 2015 (n = 11) and 2020 (n = 11) to explore how screening was conducted and factors supporting implementation. Normalization Process Theory guided interviews and content analysis. RESULTS Screening on programme level increased from 61% to 88% in hospitals and 20% to 89% in municipalities. The individual proportion of patients screened remained relatively stable in both hospitals and municipalities overall, however with considerable inter-site differences. Screening practices became more aligned to guidelines, pushed by formal recommendations and monitoring, and pulled by activities strengthening the knowledge and motivation among staff. CONCLUSION Screening for anxiety and depression improved considerably over the seven-year period, from a scattered practice driven by individuals to a movement where healthcare professionals had a feeling of going with the flow. Nationwide implementation of screening requires national and local supporting activities and a continuous effort.
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Affiliation(s)
- Cecilie Lindström Egholm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital Roskilde, Vestermarksvej 21, 4000 Roskilde, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pia Munkehøj
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Københavns Professionshøjskole, Campus Sigurdsgade, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense C, Denmark
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12
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Svendsen ML, Gadager BB, Stapelfeldt CM, Ravn MB, Palner SM, Maribo T. To what extend is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study. BMJ Open 2022; 12:e060924. [PMID: 35728905 PMCID: PMC9214391 DOI: 10.1136/bmjopen-2022-060924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES High socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR. DESIGN A population-based, follow-up study. SETTING Hospitals and primary healthcare centres in the Central Denmark Region. PARTICIPANT Patients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018). VARIABLES Four SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting. STATISTICAL METHODS The associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity. RESULTS Overall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout). CONCLUSIONS This study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD.
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Affiliation(s)
| | - Birgitte Bitsch Gadager
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christina M Stapelfeldt
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Maiken Bay Ravn
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sanne Moeller Palner
- Unit of Rehabilitation, Randers Health Centre, Randers Municipality, Randers, Denmark
| | - Thomas Maribo
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark
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13
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Ravn MB, Uhd M, Svendsen ML, Ørtenblad L, Maribo T. How to Facilitate Adherence to Cardiac Rehabilitation in Primary Health Settings for Ischaemic Heart Disease Patients. The Perspectives of Health Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:837175. [PMID: 36188961 PMCID: PMC9397980 DOI: 10.3389/fresc.2022.837175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/21/2022]
Abstract
Background Cardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood. Aim This study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings. Methods Data were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis. Results Eleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging. Conclusion This study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence.
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Affiliation(s)
- Maiken Bay Ravn
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- *Correspondence: Maiken Bay Ravn
| | - Maria Uhd
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | | | | | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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14
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Madsen MT, Juel K, Simonsen E, Gögenur I, Zwisler ADO. External validity of randomized clinical trial studying preventing depressive symptoms following acute coronary syndrome. Brain Behav 2021; 11:e02132. [PMID: 34145796 PMCID: PMC8413812 DOI: 10.1002/brb3.2132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of the current study was to quantitatively explore aspects of external validity, both researcher's choices (eligibility) and patient's choices (consent), of a recently conducted clinical trial. METHODS A cohesive comparison between the MEDACIS trial (NCT02451293) database and a national quality and research database was conducted. Comparisons between both participants and nonconsenting patients (patient consent) and participants and noneligible patients (researcher selection) were performed. Comparisons of outcomes were depressive and anxiety symptoms, demographics, and somatic or psychiatric comorbidity. RESULTS Noneligible patients had significantly higher levels of depressive symptoms and anxiety and were older and more likely to suffer from unstable angina pectoris. Furthermore, noneligible patients were less likely to be married, had a lower educational level, used more medication, and had a higher frequency of comorbidity. Nonconsenting patients had significantly higher levels of depressive symptoms and anxiety and were older and more likely to be females compared to participants. CONCLUSION Significant differences were present between noneligible patients and participants; however, more troublingly significant differences were shown between nonconsenting patients and participants. The presence of depressive symptoms and anxiety has a significant impact on patients' willingness to give informed consent in clinical trials in cardiology with a focus on psychological outcomes.
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Affiliation(s)
- Michael Tvilling Madsen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorthe Olsen Zwisler
- REHPA - Danish Knowledge Center for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,The Danish Clinical Quality Program (RKKP), Danish Cardiac Rehabilitation Database, National Clinical Registries, Aarhus, Denmark
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15
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Helmark C, Ahm R, Andersen CM, Skovbakke SJ, Kok R, Wiil UK, Schmidt T, Hjelmborg J, Frostholm L, Frydendal DH, Hansen TB, Zwisler AD, Pedersen SS. Internet-based treatment of anxiety and depression in patients with ischaemic heart disease attending cardiac rehabilitation: a feasibility study (eMindYourHeart). EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:323-335. [PMID: 36712399 PMCID: PMC9707909 DOI: 10.1093/ehjdh/ztab037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 02/01/2023]
Abstract
Aims Anxiety and depression are prevalent in 20% of patients with ischaemic heart disease (IHD); however, treatment of psychological conditions is not commonly integrated in cardiac rehabilitation (CR). Internet-based psychological treatment holds the potential to bridge this gap. To examine the feasibility of an eHealth intervention targeting anxiety and depression in patients with IHD attending CR. Methods and results We used a mixed-methods design, including quantitative methods to examine drop-out and change in anxiety and depression scores, and qualitative methods (thematic analysis) to evaluate patients' and nurses' experiences with the intervention. The therapist-guided intervention consisted of 12 modules provided via a web-based platform. The primary outcome was drop-out, with a drop-out rate <25% considered acceptable. Patients were considered as non-drop-out if they completed ≥5 modules. Out of 60 patients screened positive for anxiety and/or depression, 29 patients were included. The drop-out rate was 24% (7/29). Patients had a mean improvement in anxiety and depression scores of 5.5 and 4.6, respectively. On average, patients had 8.0 phone calls with their therapist and 19.7 written messages. The qualitative analysis of patients' experiences identified four themes: treatment platform, intervention, communication with therapist, and personal experience. Patients were positive towards the intervention, although some found the assignments burdensome. From the nurses, we identified three themes: intervention, inclusion procedure, and collaboration with study team. The nurses were positive, however, due to limited time some struggled with the inclusion procedure. Conclusion Integrating an eHealth intervention in CR is feasible and the drop-out rate acceptable.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Vestermarksvej 21, DK-4000 Roskilde, Denmark,Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark,Corresponding author. Tel: +DK 4732 6111,
| | - Robert Ahm
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Christina M Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Søren J Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Robin Kok
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Uffe K Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winslows Vej 9, DK-5000 Odense C, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Ditte H Frydendal
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Tina B Hansen
- Department of Cardiology, Zealand University Hospital, Vestermarksvej 21, DK-4000 Roskilde, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, J.B. Winslows Vej 4, DK-5000 Odense, Denmark,Danish Knowledge Center for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Vestergade 17, DK-5800 Nyborg, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark,Department of Cardiology, Odense University Hospital, J.B. Winslows Vej 4, DK-5000 Odense, Denmark,Open Patient data Explorative Network (OPEN), Odense University Hospital, J.B. Winslows Vej 9, DK-5000 Odense C, Denmark
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16
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Heart-Healthy Dietary Intake Improved and Maintained 6 Months After Participation in a Cardiac Rehabilitation Program. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe. Arch Rehabil Res Clin Transl 2021; 2:100043. [PMID: 33543072 PMCID: PMC7853368 DOI: 10.1016/j.arrct.2020.100043] [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] [Indexed: 12/28/2022] Open
Abstract
Objective To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting Comprehensive 3-week CR. Participants Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). Interventions Not applicable. Main Outcome Measures Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). Results Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. Conclusions We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.
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Key Words
- 6MWD, 6-minute walking distance
- 95% CI, 95% confidence interval
- ACS, acute coronary syndrome
- BMI, body mass index
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardiovascular diseases
- EDC, electronic data capture
- HAF-17, Herzangstfragebogen (German version of the Cardiac Anxiety Questionnaire)
- IRES-24, indicators of rehabilitation status-24
- KMO, Kaiser-Meyer-Olkin
- LDL, low-density lipoprotein
- OutCaRe, Outcome of Cardiac Rehabilitation
- Outcome measures
- PAD, peripheral artery disease
- PCS, physical component summary
- PHQ-9, Patient Health Questionnaire-9
- Quality indicators
- Rehabilitation
- Rehabilitation outcome
- SES, standardized effect size
- SF-12, Medical Outcomes Study 12-Item Short-Form Health Survey
- Secondary prevention
- WHO-5, 5-item World Health Organization Well-Being Index
- health care
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Pedersen SS, Andersen CM, Ahm R, Skovbakke SJ, Kok R, Helmark C, Wiil UK, Schmidt T, Olsen KR, Hjelmborg J, Zwisler AD, Frostholm L. Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol. BMC Cardiovasc Disord 2021; 21:20. [PMID: 33413109 PMCID: PMC7788554 DOI: 10.1186/s12872-020-01801-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety. Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death. In 2020, IHD and depression are expected to be among the top contributors to the disease-burden worldwide. Hence, it is paramount to treat both the underlying somatic disease as well as depression and anxiety. eMindYourHeart will evaluate the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention targeting depression and anxiety in patients with IHD, which may help fill this gap in clinical care. METHODS eMindYourHeart is a multi-center, two-armed, unblinded randomised controlled trial that will compare a therapist-assisted eHealth intervention to treatment as usual in 188 CR patients with IHD and comorbid depression or anxiety. The primary outcome of the trial is symptoms of depression, measured with the Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes evaluated at 3, 6, and 12 months include symptoms of depression and anxiety (HADS), perceived stress, health complaints, QoL (HeartQoL), trial dropout (number of patients dropped out in either arm at 3 months) and cost-effectiveness. DISCUSSION To our knowledge, this is the first trial to evaluate both the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention in patients with IHD and comorbid psychological distress as part of CR. Integrating screening for and treatment of depression and anxiety into standard CR may decrease dropout and facilitate better risk factor management, as it is presented as "one package" to patients, and they can access the eMindYourHeart program in their own time and at their own convenience. The trial holds a strong potential for improving the quality of care for an increasing population of patients with IHD and comorbid depression, anxiety or both, with likely benefits to patients, families, and society at large due to potential reductions in direct and indirect costs, if proven successful. Trial registration The trial was prospectively registered on https://clinicaltrials.gov/ct2/show/NCT04172974 on November 21, 2019 with registration number [NCT04172974].
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Affiliation(s)
- Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Christina M. Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robert Ahm
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robin Kok
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- Danish Center for Health Economics (DaCHE), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Danish Knowledge Center for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Andersen JH, Burns K, Guassora ADK, Cerqueira C, Jørgensen T, Lundstrøm SL. Taking no for an answer. Nurses' consultations with people with cardiac disease about rehabilitation: A qualitative study. Appl Nurs Res 2021; 58:151397. [PMID: 33745551 DOI: 10.1016/j.apnr.2021.151397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/15/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research shows that many people with cardiac disease decline cardiac rehabilitation. There is little or no knowledge on how health professionals respond to these people. OBJECTIVES To investigate how nurses respond to people who do not wish to participate in cardiac rehabilitation and what influences the nurses´ approach towards these people. DESIGN A qualitative study involving interviews and video-recordings using an analysis inspired by ethnographic principles and categorisation theory. SETTING A rehabilitation clinic at a large hospital in the Capital Region of Denmark. PARTICIPANTS Five cardiac nurses and 28 people with cardiac disease. METHODS We video-recorded the first consultation people with cardiac disease attended regarding cardiac rehabilitation, where the nurses followed up on these people's recovery, medication, lifestyle and need for rehabilitation. We conducted semi-structured interviews with the cardiac nurses. We asked the nurses about the purpose of the first rehabilitation consultation and how they handle people with cardiac disease who say no to rehabilitation. The nurses were shown video-clips with the people they had talked to in their consultation in order to facilitate a dialogue. RESULTS When people with cardiac disease were reluctant to participate in rehabilitation, the nurses made an individual assessment of how much effort to put into motivating them, taking a complex range of factors into account. The effort among the nurses towards people with cardiac disease who decline rehabilitation was smaller in cases when the nurses believed an individual would benefit less from rehabilitation or have difficulty participating. It was important for the nurses to balance their motivational efforts with showing respect for people's autonomy. CONCLUSION Even when nurses endorse rehabilitation, some people with cardiac disease decline rehabilitation. The nurses' recommendation of the rehabilitation programme is influenced by the knowledge they obtain about the people with cardiac disease during consultations.
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Affiliation(s)
- Julie Høgsgaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Boks 2099, 1014 København K., Denmark.
| | - Karin Burns
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
| | - Ann Dorrit Kristiane Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Boks 2099, 1014 København K., Denmark.
| | - Charlotte Cerqueira
- Danish Clinical Quality Program, National Clinical Registries, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 3, indgang 4, 2000 Frederiksberg. Denmark.
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
| | - Sanne Lykke Lundstrøm
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 5, 2000 Frederiksberg, Denmark.
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20
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Tang LH, Joshi V, Egholm CL, Zwisler AD. Are survivors of cardiac arrest provided with standard cardiac rehabilitation? - Results from a national survey of hospitals and municipalities in Denmark. Eur J Cardiovasc Nurs 2020; 20:115-123. [PMID: 33849060 DOI: 10.1177/1474515120946313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
AIM To quantify the provision of standard cardiac rehabilitation to Danish survivors of cardiac arrest at a programme level, and to analyse whether organizational factors influenced the provision. METHOD We mapped the provision of cardiac rehabilitation core components to survivors of cardiac arrest and compared this with a reference group of patients after acute myocardial infarction using data from a cross-sectional programme-level survey among all hospitals (n = 34) and municipalities (n = 98) in Denmark. Organizational factors of potential importance to service provision were considered: health care region, size of catchment area/population, type of department/municipality and socioeconomic index. RESULTS Response rates for the provision of each core component of cardiac rehabilitation ranged from 64% to 98%. All hospitals and municipalities provided some aspect of cardiac rehabilitation to survivors of cardiac arrest. Across hospitals, provision of four core components of cardiac rehabilitation to survivors of cardiac arrest was lower compared with post acute myocardial infarction patients: patient education (relative risk (RR) = 0.45 (95% confidence interval (CI) 0.27 to 0.75)), exercise training (RR = 0.69 (95% CI 0.49 to 0.98)), screening for anxiety and depression (RR = 0.64 (95% CI 0.46 to 0.90) and nutritional counselling RR = 0.76 (95% CI 0.62 to 0.93)). No difference was found in the provision of core components across municipalities. Overall, the provision of cardiac rehabilitation to survivors of cardiac arrest was not affected by organizational factors. CONCLUSION This study indicates a need for future research to inform the development, adoption and implementation of equal access to all components of cardiac rehabilitation for survivors of cardiac arrest in Denmark.
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Affiliation(s)
- Lars H Tang
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Slagelse, Denmark
| | - Vicky Joshi
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Cecilie Lindström Egholm
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.,The Danish Clinical Quality Program (RKKP), National Clinical Registries, Aarhus N, Denmark
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Laursen UB, Johansen MN, Joensen AM, Overvad K, Larsen ML. Is Cardiac Rehabilitation Equally Effective in Improving Dietary Intake in All Patients with Ischemic Heart Disease? J Am Coll Nutr 2020; 40:33-40. [PMID: 32459604 DOI: 10.1080/07315724.2020.1755910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the association between sociodemographic characteristics and changes in dietary intake in patients with ischemic heart disease who were following a cardiac rehabilitation program. METHODS Longitudinal study among patients with first-time admission to outpatient cardiac rehabilitation after ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina pectoris or stable angina pectoris. We used a validated self-administered food frequency questionnaire to assess the dietary intake before rehabilitation, post rehabilitation and 6 months after baseline. The intake was summarized into a fat and fish-fruit-vegetable score for both sexes. To assess the within-patient differences in dietary scores, a paired t-test was applied. Regression analyses were performed to assess the association between sociodemographic characteristics and changes in diet. RESULTS 186 patients completed two measurements, 157 patients completed all three measurements. Fat and fish-fruit-vegetable scores increased statistically significantly and improvements remained statistically significant at follow-up. Fat scores increased less in employed men than in retired men (-11 (95% CI -17; -5)). Fish-fruit-vegetable scores increased less in men with a bachelor degree than in men with a vocational education (-8 (95% CI -13; -3)) as well as in retired women compared with employed women (-18 (95% CI -32; -4)). CONCLUSIONS Patients statistically significantly improved their dietary intake and improvements remained at follow-up. Dietary improvements were sensitive to marital status, living arrangements and employment status. Unemployed and retired women did not seem to improve their diet as much as employed women. Additional dietary intervention may become relevant in some patient groups defined by sociodemographic characteristics. (250).
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Affiliation(s)
- Ulla Bach Laursen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, Aarhus University, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Thomas E, Grace SL, Boyle D, Gallagher R, Neubeck L, Cox N, Manski-Nankervis JA, Henley-Smith S, Cadilhac DA, O’Neil A. Utilising a Data Capture Tool to Populate a Cardiac Rehabilitation Registry: A Feasibility Study. Heart Lung Circ 2020; 29:224-232. [DOI: 10.1016/j.hlc.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/26/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
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Frederiksen HW, Zwisler AD, Johnsen SP, Öztürk B, Lindhardt T, Norredam M. Differences in initiation and discontinuation of preventive medications and use of non-pharmacological interventions after acute coronary syndrome among migrants and Danish-born. Eur Heart J 2019; 39:2356-2364. [PMID: 29718168 DOI: 10.1093/eurheartj/ehy227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Aims The aim of this article is to assess initiation and discontinuation of preventive medication and use of non-pharmacological prevention interventions after acute coronary syndrome (ACS) among migrants to Denmark compared to the local-born Danish population, taking differences in comorbidity and sociodemographic factors into account. Methods and results In this large cohort study, we selected the population (n = 33 199) from nationwide registers and followed each individual among migrants and Danish-born 180 days after ACS. We identified the initiation and discontinuation of medications and the initiation and number of contacts for non-pharmacological interventions in the Register of Medicinal Products Statistics and the National Patient Register, and adjusted for comorbidity and sociodemographic factors. Non-Western migrants had lower relative risks for initiating adenosine diphosphate receptor (ADP)- and angiotensin-converting enzyme (ACE)-inhibitors (0.93, CI: 0.90; 0.96, and 0.91, CI: 0.87; 0.96) and patient education (0.95, CI: 0.92; 0.98). Further, non-Western migrants had higher hazard ratios for discontinuing medications (statins: 1.64, CI: 1.45; 1.86, ADP-inhibitors: 1.72, CI: 1.50; 1.97, β-blockers: 1.52, CI: 1.40; 1.64, and ACE-inhibitors: 1.72, CI: 1.46; 2.02), and fewer contacts for physical exercise and patient education (P < 0.001 and P = 0.011). Conclusion We identified differences between non-Western migrants and Danish-born in initiation and discontinuation of preventive medications and use of non-pharmacological interventions after ACS. These differences could not be explained by differences in comorbidity or sociodemographic factors.
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Affiliation(s)
- Hanne Winther Frederiksen
- Department of Internal Medicine, Copenhagen University Hospital, Herlev, Herlev ringvej 75, Herlev, Denmark.,Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, Copenhagen, Denmark.,University College Capital, Humletorvet 3, København V, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Vestergade 17, Nyborg, Denmark.,Odense University Hospital, Odense, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital, Herlev, Herlev ringvej 75, Herlev, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, Copenhagen, Denmark
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Geneviève LD, Martani A, Mallet MC, Wangmo T, Elger BS. Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. OBJECTIVE This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland. METHODS Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. RESULTS Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. CONCLUSION This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Affiliation(s)
| | - Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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National survey of current practice and opinions on rehabilitation for intermittent claudication in the Danish Public Healthcare System. SCAND CARDIOVASC J 2019; 53:361-372. [PMID: 31394936 DOI: 10.1080/14017431.2019.1654614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective. International guidelines recommend rehabilitation including supervised exercise therapy in patients with Intermittent Claudication (IC), but knowledge of the implementation in clinical practice is limited. This study aims to investigate current practice and opinions on rehabilitation for patients with IC among vascular surgeons and rehabilitation departments in the municipalities and hospitals. Design. Three electronic cross-sectional surveys were distributed nationally to the Danish vascular surgeons (n = 131) and to rehabilitation departments in the municipalities (n = 92) and hospitals (n = 33). Results. The response rates were 70% among the vascular surgeons, 98% among the municipalities and 94% among the hospitals. Vascular surgeons utilize oral advice to exercise by self-administered walking, pharmacological treatment, and revascularization to improve walking distance in patients with IC. Currently, only 12% of the vascular surgeons referred to rehabilitation to improve walking distance, while almost all vascular surgeons (96%) would refer their patients to IC rehabilitation, if it was available. Only 14% of municipalities and none of the hospitals, who treat patients with IC, have a rehabilitation program designed specifically for patients with IC. However, 59% of the rehabilitation departments in the municipalities and 26% in the hospitals included patients with IC in rehabilitation program designed for other patient groups - mostly cardiac patients. There was consensus among the groups of respondents that future IC specific rehabilitation should include an initial conversation, supervised exercise therapy, smoking cessation, and patient education according to guidelines. Conclusion. Vascular surgeons support referral and participation in IC rehabilitation to improve walking distance in patients with IC. Despite some hospitals and municipalities included patients with IC in rehabilitation nearly all services fail to meet current guideline as specific services tailored to patient with IC is almost non-existent in Denmark. Our findings call for action for services to comply with current recommendations of structured, systematic rehabilitation for patients with IC.
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Rossen S, Trier K, Christensen B, Eriksen MA, Zwisler AD, Vibe-Petersen J. Municipality-based pragmatic rehabilitation stratified in accordance with individual needs-results from a longitudinal survey study. Support Care Cancer 2019; 28:1951-1961. [PMID: 31375907 DOI: 10.1007/s00520-019-04993-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/11/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evidence on municipality-based cancer rehabilitation is sparse. This longitudinal study explores the following: (1) Rehabilitation needs, (2) effectiveness of municipality-based rehabilitation, and (3) whether rehabilitative services are stratified according to individual needs in breast cancer patients. METHODS We collected data from a longitudinal survey among 82 breast cancer patients referred to municipality-based rehabilitation at the Copenhagen Centre for Cancer and Health. Rehabilitation needs, health-related quality of life (HRQoL), and functional status were collected using patient-reported outcomes (PROs) including distress thermometer, problem list, Functional Assessment of Cancer Therapy-Breast questionnaire (FACT-B), and upper body function with the abbreviated disability of the arm, shoulder, and hand (Quick-DASH) questionnaire. Data collection time points are as follows: entry, follow-up, and end of intervention. RESULTS At referral, scores were (mean (range)) distress 4.0 (0-10), problems 9.5 (0-24), and FACT-B 103.0 (49.8-135.5). HRQoL increased during rehabilitation (FACT-B ∆ mean 8.1 points (> MID, p < 0.0001)); 56% had a positive change, 34% no difference, and 11% a decline. Those with the lowest FACT-B entry score had significantly longer duration of rehabilitation (10.9 vs 8.7 months, p < 0.001), higher number of services (7.0 vs 5.3, p < 0.003), and participated more in group-based exercise (+3 sessions: 57% vs 8%, p < 0.001). CONCLUSION This is the first study to report on pragmatic municipality-based cancer rehabilitation. The results suggest that services are aimed at patients with rehabilitation needs, improve HRQoL, and are properly stratified to those who need it the most. We suggest future monitoring of municipality-based rehabilitation services to ensure quality of care.
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Affiliation(s)
- Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark.
| | - Karen Trier
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark
| | - Berit Christensen
- Department for Data and Analysis, Municipality of Copenhagen, Sjællandsgade 40, DK-2200, Copenhagen N, Denmark
| | - Martina A Eriksen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Vestergade 17, DK-5800, Nyborg, Denmark
| | - Jette Vibe-Petersen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Alle 45, DK-2200, Copenhagen N, Denmark
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Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, Sørensen HT. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 2019; 11:563-591. [PMID: 31372058 PMCID: PMC6634267 DOI: 10.2147/clep.s179083] [Citation(s) in RCA: 749] [Impact Index Per Article: 149.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/20/2019] [Indexed: 01/04/2023] Open
Abstract
Denmark has a large network of population-based medical databases, which routinely collect high-quality data as a by-product of health care provision. The Danish medical databases include administrative, health, and clinical quality databases. Understanding the full research potential of these data sources requires insight into the underlying health care system. This review describes key elements of the Danish health care system from planning and delivery to record generation. First, it presents the history of the health care system, its overall organization and financing. Second, it details delivery of primary, hospital, psychiatric, and elderly care. Third, the path from a health care contact to a database record is followed. Finally, an overview of the available data sources is presented. This review discusses the data quality of each type of medical database and describes the relative technical ease and cost-effectiveness of exact individual-level linkage among them. It is shown, from an epidemiological point of view, how Denmark’s population represents an open dynamic cohort with complete long-term follow-up, censored only at emigration or death. It is concluded that Denmark’s constellation of universal health care, long-standing routine registration of most health and life events, and the possibility of exact individual-level data linkage provides unlimited possibilities for epidemiological research.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Sigrun Alba Johannesdottir Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Lindström Egholm C, Helmark C, Christensen J, Eldh AC, Winblad U, Bunkenborg G, Zwisler AD, Nilsen P. Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database. BMJ Open 2019; 9:e028291. [PMID: 31196902 PMCID: PMC6576126 DOI: 10.1136/bmjopen-2018-028291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. DESIGN Cross-sectional nationwide survey study. SETTING, METHODS AND PARTICIPANTS A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. RESULTS Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). CONCLUSIONS The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
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Affiliation(s)
- Cecilie Lindström Egholm
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbaek University Hospital, Holbaek, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Roskilde, Denmark
| | - Jan Christensen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gitte Bunkenborg
- Department of Anesthesiology, Holbaek University Hospital, Holbaek, Denmark
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Frederiksen HW, Zwisler AD, Johnsen SP, Öztürk B, Lindhardt T, Norredam M. Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome. J Am Heart Assoc 2019; 8:e009528. [PMID: 31140348 PMCID: PMC6585379 DOI: 10.1161/jaha.118.009528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The benefits of preventive medications after acute coronary syndrome are impeded by low medication persistence, in particular among marginalized patient groups. Patient education might increase medication persistence, but the effect is still uncertain, especially among migrant groups. We, therefore, assessed whether use of patient education was associated with medication persistence after acute coronary syndrome and whether migrant background modified the potential associations. Methods and Results A cohort of patients discharged with a diagnosis of acute coronary syndrome (N=33 199) was identified in national registers. We then assessed number of contacts for patient education during a period of 6 months after discharge and the initiation and discontinuation of preventive medications during a period of up to 5 years. Results were adjusted for comorbidity and sociodemographic factors. Three or more contacts for patient education was associated with a higher likelihood of initiating preventive medications, corresponding to adjusted relative risks ranging from 1.12 (95% CI , 1.06-1.18) for statins to 1.39 (95% CI , 1.28-1.51) for ADP inhibitors. Lower risks of subsequent discontinuation were also observed, with adjusted hazard ratios ranging from 0.86 (95% CI , 0.79-0.92) for statins to 0.92 (95% CI , 0.88-0.97) for β blockers. Stratification and test for effect modification by migrant status showed insignificant effect modification, except for initiation of ADP inhibitors and statins. Conclusions Patient education is associated with higher chance of initiating preventive medications after acute coronary syndrome and a lower long-term risk of subsequent discontinuation independently of migrant status.
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Affiliation(s)
- Hanne Winther Frederiksen
- 1 Department of Internal Medicine Copenhagen University Hospital Herlev Denmark.,2 Danish Research Centre for Migration, Ethnicity and Health University of Copenhagen Copenhagen Denmark.,5 Section of Immigrant Medicine Department of Infectious Diseases University Hospital Hvidovre Hvidovre Denmark
| | - Ann-Dorthe Zwisler
- 3 Danish Knowledge Centre for Rehabilitation and Palliative Care University of Southern Denmark Odense Denmark
| | | | - Buket Öztürk
- 4 Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Tove Lindhardt
- 1 Department of Internal Medicine Copenhagen University Hospital Herlev Denmark
| | - Marie Norredam
- 2 Danish Research Centre for Migration, Ethnicity and Health University of Copenhagen Copenhagen Denmark.,5 Section of Immigrant Medicine Department of Infectious Diseases University Hospital Hvidovre Hvidovre Denmark
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Egholm CL, Helmark C, Doherty P, Nilsen P, Zwisler AD, Bunkenborg G. "Struggling with practices" - a qualitative study of factors influencing the implementation of clinical quality registries for cardiac rehabilitation in England and Denmark. BMC Health Serv Res 2019; 19:102. [PMID: 30728028 PMCID: PMC6366013 DOI: 10.1186/s12913-019-3940-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022] Open
Abstract
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. Electronic supplementary material The online version of this article (10.1186/s12913-019-3940-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilie Lindström Egholm
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Southern Region of Denmark, Vestergade 17, 5800, Nyborg, Denmark. .,Department of Medicine, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Region Zealand, Denmark.
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, 4000, Roskilde, Denmark
| | - Patrick Doherty
- The National Audit of Cardiac Rehabilitation, Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Campus US, Hus 511-001, ingång 76, plan 13, 58183, Linköping, Sweden
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Southern Region of Denmark, Vestergade 17, 5800, Nyborg, Denmark
| | - Gitte Bunkenborg
- Department of Anaestesiology, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Region Zealand, Denmark
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Zecchin R, Candelaria D, Ferry C, Ladak LA, McIvor D, Wilcox K, Bennett A, Bowen S, Carr B, Randall S, Gallagher R. Development of Quality Indicators for Cardiac Rehabilitation in Australia: A Modified Delphi Method and Pilot Test. Heart Lung Circ 2018; 28:1622-1630. [PMID: 30220480 DOI: 10.1016/j.hlc.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/01/2018] [Accepted: 08/20/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND International guidelines recommend cardiac rehabilitation (CR) for secondary prevention of cardiovascular disease, however, it is underutilised and the quality of content and delivery varies widely. Quality indicators (QIs) for CR are used internationally to measure clinical practice performance, but are lacking in the Australian context. This study reports the development of QIs for minimum dataset (MDS) for CR and the results of a pilot test for feasibility and applicability in clinical practice in Australia. METHODS A modified Delphi method was used to develop initial QIs which involved a consensus approach through a series of face-to-face and teleconference meetings of an expert multidisciplinary panel (n=8), supplemented by an environmental scan of the literature and a multi-site pilot test. RESULTS Eight (8) QIs were proposed and sent to CR clinicians (n=250) electronically to rate importance, current data collection status, and feasibility of future collection. The top six of these QIs were selected with an additional two key performance indicators from the New South Wales (NSW) Ministry of Health and two QIs from international registers for a draft MDS. The pilot test in 16 sites (938 patient cases) demonstrated median performance of 93% (IQR 47.1-100%). All 10 QIs were retained and one further QI related to diabetes was added for a final draft MDS. CONCLUSIONS The MDS of 11 QIs for CR provides an important foundation for collection of data to promote the quality of CR nationally and the opportunity to participate in international benchmarking.
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Affiliation(s)
- Robert Zecchin
- Western Sydney Local Health District (LHD), Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Dion Candelaria
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Cate Ferry
- National Heart Foundation of Australia (New South Wales Division), Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Laila Akbar Ladak
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Dawn McIvor
- Hunter New England LHD, Newcastle, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Kerry Wilcox
- Northern NSW LHD, Lismore, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | | | - Sheryl Bowen
- Mid North Coast LHD, Coffs Harbour, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Bridie Carr
- Agency for Clinical Innovation (ACI) NSW, Sydney, NSW, Australia
| | - Sue Randall
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia.
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Kristensen MB, Dieperink KB, Rossau HK, Egholm CL, Viggers L, Bertelsen BM, Zwisler AD. Dietary interventions in cardiac rehabilitation - The gap between guidelines and clinical practice. Clin Nutr ESPEN 2018; 27:120-126. [PMID: 30144884 DOI: 10.1016/j.clnesp.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS An unhealthy diet is a risk factor for ischemic heart disease (IHD) and therefore cardiac rehabilitation (CR) should include dietary interventions. In 2007, CR became a shared responsibility between Danish hospitals and municipalities. Later, a national clinical guideline including recommendations on dietary interventions was developed to facilitate implementation of CR. The aim of the present study is: 1) To describe provision of dietary interventions in CR for IHD patients in Denmark in 2013 and 2015 emphasizing differences between hospitals and municipalities, and 2) To evaluate the implementation of the national clinical guideline in clinical practice. METHODS A repeated nationwide cross-sectional electronic survey was carried out in 2013 and 2015. Participation was mandatory for all Danish hospital departments offering CR (n = 36), but voluntary for municipalities (n = 98) reaching response rates of 82% and 89% in 2013 and 2015, respectively. The electronic survey covered the core components of dietary interventions in CR as described in the national clinical guideline. RESULTS In 2015, 72% of municipalities provided dietary interventions. This proportion was significantly higher in hospitals (94%, p = 0.007). 26% and 38% of hospitals screened systematically for dietary intervention needs in 2013 and 2015, respectively. Corresponding results from municipalities were 26% and 29%. No significant differences were seen in clinical practice over time. CONCLUSIONS The results of this study identified a major gap between recommendations in the national clinical guideline and actual clinical practice on dietary interventions in CR in Danish hospitals and municipalities. The study confirmed that implementation of guidelines in clinical practice takes time and requires an intensive effort.
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Affiliation(s)
- Marianne Boll Kristensen
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Bachelor's Degree Programme in Nutrition and Health, University College Copenhagen, Sigurdsgade 26, DK-2200 Copenhagen N, Denmark.
| | - Karin B Dieperink
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
| | - Henriette Knold Rossau
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark.
| | - Cecilie Lindström Egholm
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark; Department of Medicine, Holbæk University Hospital, Region Zealand, Smedelundsgade 60, DK-4300, Holbæk, Denmark.
| | - Lone Viggers
- Department of Nutrition, Regional Hospital West Jutland, Lægårdvej 12, DK-7500, Holstebro, Denmark; The Danish Dietetic Association, Skt. Annæ Plads 6, DK-1250, Copenhagen K, Denmark.
| | - Birgitte Møllegaard Bertelsen
- Department of Medicine, Hospital South West Jutland, Finsensgade 35, DK-6700, Esbjerg, Denmark; The Danish Dietetic Association, Skt. Annæ Plads 6, DK-1250, Copenhagen K, Denmark.
| | - Ann-Dorthe Zwisler
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, DK-5700, Nyborg, Denmark.
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Lindström Egholm C, Rossau HK, Nilsen P, Bunkenborg G, Rod MH, Doherty P, Bartels P, Helmark L, Zwisler AD. Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark. Health Policy 2018; 122:1043-1051. [PMID: 30093082 DOI: 10.1016/j.healthpol.2018.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022]
Abstract
A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guideline´s aim of uniform, evidence-based content of CR services across settings.
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Affiliation(s)
- Cecilie Lindström Egholm
- Department of Medicine, Holbæk University Hospital, Region Zealand, Holbæk, Denmark; Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
| | - Henriette Knold Rossau
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gitte Bunkenborg
- Department of Anesthesiology, Holbæk University Hospital, Region Zealand, Holbæk, Denmark
| | - Morten Hulvej Rod
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | | | - Lotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Schmidt M, Maeng M, Madsen M, Sørensen HT, Jensen LO, Jakobsen CJ. The Western Denmark Heart Registry. J Am Coll Cardiol 2018; 71:1259-1272. [DOI: 10.1016/j.jacc.2017.10.110] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 10/17/2022]
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Poffley A, Thomas E, Grace SL, Neubeck L, Gallagher R, Niebauer J, O’Neil A. A systematic review of cardiac rehabilitation registries. Eur J Prev Cardiol 2017; 24:1596-1609. [DOI: 10.1177/2047487317724576] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alison Poffley
- UNC Gillings School of Global Public Health, University of North Carolina, USA
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Sherry L Grace
- Faculty of Health, York University and University Health Network, Canada
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, UK
| | | | - Josef Niebauer
- Institute of Sports Medicine, Prevention, and Rehabilitation, Paracelsus Medical University, Austria
| | - Adrienne O’Neil
- Melbourne School of Population and Global Health, University of Melbourne, Australia
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