a qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral：转诊对心脏康复计划影响的定性系统评价.pdfVIP

Curriculum in Cardiology A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral Alexander M. Clark, PhD, a Kathryn M. King-Shier, PhD, b David R. Thompson, PhD, c Melisa A. Spaling, MEd, a Amanda S. Duncan, MA, a James A. Stone, MD, PhD, d,e,f Susan B. Jaglal, PhD, g and Jan E. Angus, PhD h Alberta, and Ontario, Canada; and Melbourne, Australia Background Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood. Methods A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995. Results Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients decisions to attend. The main personal factors affecting attendance after referral included patients knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influence