A Nationwide pilot project to develop rehabilitation services for patients with cardiovascular diseases
Marina Bubnova, David Aronov, Olga Barbarash, Nadezhda Lyamina, Svetlana Pomeshkina, Galina Chumakova, on behalf of the Pilot Project Research Group
Department for Rehabilitation and Secondary Prevention, Federal State Budgetary Institution National Medical Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Objective: To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases.
Methods: Seventeen hospital and outpatient medical centres from 13 regions of the Pilot Project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation.
Results: The pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients’ stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017.
Conclusion: Despite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.
Within the 5-year follow-up, we evaluated the implementation of a three-phase rehabilitation programme based on the multidisciplinary approach for patients with cardiovascular diseases in 17 healthcare institutions located in 13 cities of the Russian Federation. By the end of 2017, phases 1 and 2 cardiac rehabilitation fully corresponded to the main principles stated in the Russian clinical guidelines. All patients underwent educational sessions and physical exercise. The implementation of phase 3 cardiac rehabilitation proved to be the most difficult one to implement as it required the establishment of separate outpatient cardiac rehabilitation departments with the necessary sports gear and specialists. Thus, further improvement of rehabilitation programs is necessary. Special attention needs to be focused on the standards and principles of providing phase 3 cardiac rehabilitation followed by the introduction of the three-phase cardiac rehabilitation in other regions of the country.
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