Cardiac psychology training in a rural health care setting: East Carolina Heart Institute.

Abstract

The full partnership of clinical health psychology and cardiology optimizes patient-centered care to address the mental and behavioral needs of patients living with heart disease. This scenario is realized as the East Carolina Heart Institute (ECHI) at East Carolina University (ECU) in Greenville, North Caroline with colocation and co-training of psychologists and cardiologists. ECHI provides services to patients across the full disease continuum of cardiovascular disease (CVD), given the higher rates of heart disease in this rural area. The purpose of this article is to describe the cardiovascular behavioral medicine training model for clinical health psychology doctoral students and its adaptation during the coronavirus disease 2019 (COVID-19) era. Through illustrative case examples, we describe the training model before the COVID-19 pandemic, during the transition to telehealth following the onset of the COVID-19 pandemic, and then the entirely telehealth-based service model. We highlight notable strengths and challenges to delivering telehealth care to cardiac patients in a rural setting, while also discussing the health disparities that uniquely occur within this patient population in Eastern North Carolina. This innovative partnership fosters a responsive environment for training and clinical care, where the complex needs of patients with CVD are treated to increase their overall quality of life and well-being.

If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine.

“…We believe this will require actions both inside and outside the care pathway. Inside the care pathway, faculty members in departments of psychology that offer a doctoral degree in clinical health psychology must participate in the effort to create and/or expand integrated CVBM services at their institutions, following the examples of Sall et al (2022) and Sears et al (2022) in this issue. We believe we should also follow the example of our colleagues involved in medical training.…”

“…For many faculty members in clinical health psychology training programs, this will be fraught with obstacles and will require some uncomfortable changes. We point to the papers by Sall et al (2022), Vela and Feingold (2022), Sears et al (2022), and Gaffey et al (2022) for roadmaps to undertaking this revamping of our clinical training.…”

“…Concerning the second question, we believe that the time for change is now. Our field has generated sufficient evidence to move full steam ahead with a research agenda emphasizing clinical trials and implementation science (Stoney et al, 2022), and we have strong exemplars in integrated cardiovascular care (Gaffey et al, 2022; Sears et al, 2022; Vela & Feingold, 2022) and training (Sall et al, 2022) that can be replicated elsewhere. But where to start?…”

“…Thus, we recommend that CVBM scientists and practitioners start where there is the least amount of resistance—that is, where they have influence and can see clear pathways to desired outcomes. To illustrate, because one of us (JCS) has ongoing research collaborations with the chief of cardiology at his institution, he could use this connection to explore the Division of Cardiovascular Medicine’s need for and interest in establishing an integrated cardiovascular care practicum, modeled after the East Carolina Heart Institute program (Sall et al, 2022), in collaboration with the Department of Psychology. Beyond providing direct benefits to patients and their families, such an experience would also enrich the training of clinical health psychology PhD students on his campus and could pave the way to a future CVBM clinical service line and additional cross-disciplinary research collaborations.…”

“…Among the papers in this issue, the one by Sall et al (2022) describing the training program at Eastern Carolina University (ECU) comes closest to this training model. The papers by Vela and Feingold (2022) and Sears et al (2022) describe the integrated cardiovascular care that would offer a context for this training, and the paper by Gaffey et al (2022) speaks in detail to how such a model might be applied for the care of patients with peripheral vascular disease or heart failure.…”