Historie. - Tuberkulosesanatorium. - Nervesanatorium. - Hjerneskade rehab. - Specialiseret rehabilitering

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2 Historie - Tuberkulosesanatorium - Nervesanatorium - Hjerneskade rehab - Specialiseret rehabilitering

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4 Commission on Accreditation of Rehabilitation Facilities Akkrediterede rehab centre 1.st i Danmark International standard Patient fokus Kvalitetssikring Performance Improvement

5 P A Sundhedscenter/Forebyggelse T I Rehabilitering/Specialiseret genoptræning E N Hospitalscenter/ Speciallæge/Rekreation T

6 Specialiseret genoptræning & Rehabilitering P A T I E Program ledere PN DR DR PN ASH/DR Læger EG/JT Psykologer SMH Soc.rdg. - PN Ergo & pæd G Fysioterapeuter - H Pleje/døgn MF Sekretær- SuB Rehab chef N T Marketing Visitation Neuro Hjerte Hjerneskadeteam (VISO) Kræft rehab Psyko-social rehab Faglige ledere

7 Rekreation på Vejlefjord

8 Omsorg, ro, pleje eller genoptræning - eksempelvis efter operation eller længere tids sygdom Sygeplejerske hele døgnet Læge til rådighed hele døgnet Daglig fysioterapi Tilkøb af andre terapeutiske ydelser

9 Hjerte stien Daglig fysioterapi Varmtvands bassin

10 Neurorehabilitering Børne-neurocenter Voksne med erhvervet hjerneskade 79 Botræning for årige Højst specialiseret personale

11 Evidens Jo mere tid med patienten - jo bedre effekt G. DeJong, Post Stroke Rehabilitation Outcome Project(PSROP), Arch Phys Med Rehabil Vol 85, April 2004 Topics in Stroke, 2003

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13 Evidensniveauer Praksis anbefalinger Grad I Lodtrækning Retningslinie(Standard) Grad II Grp. studier Guideline Grad III Single case En overvejelse værd Ekspert konsensus Det bedst indtil videre

14 Individualised menu driven Cardiac Rehabilitation. A decade of guidelines The process begins with assessments regarding all relevant aspects of the patient's status: medical, nutritional, psychosocial, educational, and vocational. The implementation of cardiac rehabilitation, based on these initial assessments, is designed to address the individual patient's needs as he or she works toward achieving optimal outcomes. Wenger NK, Froelicher ES, et al. Clinical Practice Guideline No. 17. October Rehabilitation should be tailored to the individual needs of the patient Working Group on Rehabilitation, British Cardiac Society, 1995 A menu-based approach recognises the need to tailor the delivery of services to the individual, and.. to include specific education to reduce cardiac misconceptions SIGN Guideline for CR, 2001 Comprehensive cardiac rehabilitation should embrace a case management approach. (A) Hospital based cardiac rehabilitation must be comprehensive and should be individualised to meet the needs of each patient. (D) New Zealand Guidelines 2002

15 Hjerterehabilitering Fysisk genoptræning Mål-risikofaktor kontrol Psykosocial screening Angst & Depression Minimums-kompetencer DCS holdningspapir, okt (Patient undervisning)

16 A sample menu Activity / Fitness hosp exercise group home exercise programme advice on resumption of active life Age Concern Health Mentor Walk for Health Phase 4 exercise programme Tai Chi classes Smoking Willpower alone smoking cessation clinic Nicotine replacement Referral for medication Internet programme Diet / Weight loss Self-management of diet / medication dietetics referral Weight Watchers Internet programme Coach Programme Education hospital educational programme home educational programme Mentor / volunteer / lay-worker Internet Psychological adjustment Self help advice materials Stress management class Stress management on tape Counselling psychologist Clinical Psychology / Psychiatry Social support Buddy system Patient support group Mentoring scheme Other services / Professions 1. Sexual medicine clinic 2. Welfare rights bureau 3. Social worker 4. Marriage guidance services 5. specialist heart failure nurse

17 Psychological illness in post-mi patients 90% 60% ANXIETY ACUTE EVENT IN HOSPITAL LEAVE HOSPITAL 40% AT HOME RETURN WORK 35% depression 15% 30% TIME 1 MONTH 3 MONTHS AFTER DISCHARGE 5 YEARS AFTER MI

18 Kognitiv-Adf Adfærds Orienteret Hjerte Rehab Program Angst & depression reduceres QoL forbedres Færre og mindre invalidrende symptomer Øget aktivitetsniveau Fysisk form forbedres Færre genindlæggelser works in MI, Angina, Syndrome X, CF Færre besøg hos egen læge Bob Lewin, University of York, Bob Lewin, University of York,

19 Individualised menu based cardiac rehabilitation First task. Assessment* Medical, lifestyle, psychological, social. Repeated (brief) contact To: review goals; set new targets; provide rewarding feedback; encourage problem solving of any barriers to progress. After a few weeks Change menu choices if agreed method not working. Fade out support. *BHF BACR Minimum dataset for cardiac rehabilitation. Lewin, BJC, (in press) Second task. Check for cardiac misconceptions, discuss and agree goals using motivational techniques, jointly choose a method from the menu. Discuss Menu, negotiate actions Third task. provide method for patient self-recording progress, set initial easy targets with patient. Final task. Reassess using same measures Discuss long term maintenance & a plan in case of relapse, refer on if necessary, share outcomes.

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21 Referencer SIGN 2002, #57 Cardiac Rehabilitation Hjerterehablitering MTV 2006 Bob Lewin,, University of York, DCS Holdningspapir okt. 2008

22 Hjerterehabilitering Status Marketing 27 henvisninger 8 samtykke 6 er visiteret 8 driftsforudsætning

23 Fremtid Hjerterehabilitering Kræftrehabilitering Orthopæd.kir. rehab ADHD Kroniske lidelser

24 The Angina Management Programme: trial patients randomly allocated to routine care control Exercise programme Angina Management Programme Episodes of Angina * Anxiety (HAD) Depression (HAD) * Disability (SIP) 6 months post treatment ( * = p<0.01, = p<0.001) Treadmill workload (METS) *