Study On The Current Situation And Barriers Of The Clinical Implementation Of Guidelines Of Cardiac Rehabilitation

Objective1.Systematically review and evaluate the current cardiac rehabilitation clinical practice guidelines,sort out and analyze the currently available best evidence,and summarize and sort out the recommendations of cardiac rehabilitation clinical practice guidelines.2.Based on the KTA and referencing the recommendations of clinical practice guidelines for cardiac rehabilitation,a questionnaire was developed to investigate the status of clinical practice guidelines for cardiac rehabilitation and the barriers to the implementation of the guidelines.3.To investigate the current situation of the clinical implementation of clinical practice guidelines and the barriers in the implementation process to clarify the gap between the clinical guidelines and clinical practice to propose corresponding strategies and provide reference for the clinical practice of the clinical practice guidelines.Methods1.Retrieve the clinical practice guidelines on cardiac rehabilitation at home and abroad in January 1,2011-2020 on May 31,and evaluate guidelines according to the criteria for screening guidelines based on the AGREE Ⅱ,and translate the guidelines recommendations,and by the expert letter consultation to form the final cardiac rehabilitation clinical practice guidelines recommendations summary table.2.Based on the KTA,combined with the summary table of recommendations and the results of literature analysis and qualitative interview,a preliminary questionnaire was prepared,and a questionnaire on the status quo and barriers of the implementation of guidelines,a research tool,was formed through expert letter consultation.3.Doctors,nurses and rehabilitation therapists were randomly selected from the department of cardiology,cardiac surgery,cardiac rehabilitation and other related departments in 8 Grade A hospitals in Tianjin to investigate the clinical implementation.SPSS 22.0 software was used for statistical analysis.Enumeration data were described by frequency percentage,measurement data were described by mean standard deviation,and inter-group comparison was statistically analyzed by t-test or chi-square.Results1.19 relevant guidelines were initially screened and their quality was evaluated by using the AGREEⅡ.Among them,9 guidelines were recommended as Level A,6 guidelines were recommended as Level B,and 4 guidelines were rated as Level C.A total of 8 guidelines for data extraction were published in the United States,Scotland,Europe and New Zealand respectively.A total of 103 recommendations were extracted from the 8 guidelines,which were integrated into 51 recommendations divided into 13 themes.After the expert’s argumentation,42 comprehensive recommendations were finally considered and included in the questionnaire survey,divided into 12 topics.2.Based on the KTA,combined with the comprehensive recommendations and the results of qualitative interviews,a questionnaire was developed to investigate the current situation and barriers of the implementation.The questionnaire consisted of two parts which one contains 12 dimensions and 29 items;the second was a questionnaire on barriers to the implementation of guidelines.The result showed that I-CVI ranged from 0.765 to 1.00,the S-CVI/UA was 0.822,and the S-CVI/AVE was 0.978.3.According to the investigation,the average percentage of clinical implementation of recommendations on 12 topics was 64.87%,and the top three topics were risk factor management(79.00%),lifestyle change(75.37%)and diet management(71.20%).The following three topics were sports and physical activity(52.87%),psychosocial health(53.36%)and vocational rehabilitation(54.93%).The results of the investigation on implementation barriers showed that the standardized average score of each dimension of obstacles from the highest to the bottom was the patient-related factors(3.41±0.72),resource-related factors(3.32±0.78),team-related factors(3.12±0.64),organization-related factors(2.96±0.58)and evidence-related factors(2.95±0.68).Barriers to the entries agree ratio greater than 85%respectively are the current education system of cardiac rehabilitation,lacking of training the ability of resources such as materials and education personnel experience(88.74%),understanding insufficiency with cardiac rehabilitation benefit(88.10%),lacking of human resources to complete the guidelines implementation(86.15%),awareness of cardiac rehabilitation is low(85.71%)and patients worry about cost/economic burden(85.06%).Conclusion1.8 guidelines for cardiac rehabilitation were included,with a large number of guidelines and a high overall quality.The recommendations were rich in content,covering various aspects such as exercise,diet,smoking cessation,psychological life quality,etc.,which provided a good evidence basis for clinical practice of cardiac rehabilitation and had strong clinical guiding significance.2.Based on the KTA,combined with literature research and qualitative interview,the questionnaire of clinical implementation status and hindrance factors of cardiac rehabilitation related guidelines formed after expert letter consultation and pre-investigation is scientific and reliable,and can provide a tool for the investigation of clinical implementation status and hindrance factors of cardiac rehabilitation related guidelines.3.The 42 recommendations have been widely practiced in the clinical medical care environment,but the clinical implementation of different recommendations is uneven,and the clinical implementation still needs to be further standardized and comprehensive.The barriers affecting clinical practice are complex and varied,mainly including educational resources and human resources,and patients’ cognition and cost of cardiac rehabilitation,and that medical workers are not clear about their role in change.