Cardiac Specialists' Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting.

IF 2.3 Q1 REHABILITATION Rehabilitation Process and Outcome Pub Date : 2020-08-25 eCollection Date: 2020-01-01 DOI:10.1177/1179572720936648
Mahdieh Ghanbari-Firoozabadi, Masoud Mirzaei, Khadijeh Nasiriani, Mozhgan Hemati, Jamal Entezari, Mohammadreza Vafaeinasab, Sherry L Grace, Hasan Jafary, Seyed Mahmood Sadrbafghi
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引用次数: 4

Abstract

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively.

Aim: This study investigated cardiac specialists' perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral.

Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group.

Results: Four themes emerged: "physician factors," "center factors," "patient factors," and "cultural factors." Regarding "physician factors," most participants mentioned shortage of time. Regarding "center factors," most participants mentioned poor physician-patient-center coordination. In "patient factors," the subcategories that arose were socioeconomic challenges and clinical condition of the patients. "Cultural factors" related to lack of belief in behavioral/preventive medicine.

Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

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心脏专家对低资源环境下心脏康复转诊和参与障碍的看法。
背景:在确保患者获得心脏康复(CR)方面,心脏病专家可以说是最有影响力的提供者。医生转诊障碍在高收入环境之外的调查很少,而且没有定性。目的:本研究调查了心脏病专家对低资源环境下患者CR参与的障碍和促进因素的看法,重点是转诊。方法:在定性研究中,采用常规的内容分析方法进行焦点小组研究。在伊朗亚兹德工作的14名合格心脏专家中,有13名参加了一个或两个焦点小组(分别为n = 9和n = 10)。将第一次焦点小组的记录逐字抄写成word文件,所有现场笔记和抄本内容的准确性经研究小组批准,然后进行归纳分析。经过类似的过程,第二个焦点小组达到饱和。结果:出现了四个主题:“医生因素”、“中心因素”、“患者因素”和“文化因素”。关于“医生因素”,大多数参与者提到时间短缺。关于“中心因素”,大多数参与者提到了较差的医患中心协调。在“患者因素”中,出现的子类别是社会经济挑战和患者的临床状况。“文化因素”与缺乏对行为/预防医学的信念有关。结论:在高资源环境中,CR转诊和参与的障碍是多层次的。然而,在这些环境中引入CR的时间相对较短,似乎引起了极大的缺乏认识。文化信仰可能会有所不同,在这种情况下,从CR项目到转诊提供者的沟通是一个特别的挑战。
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审稿时长
8 weeks
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