Cardiac rehabilitation in rural and remote areas of North Queensland: How well are we doing?

Abstract

Objective: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). ( 2) propose changes to improve access to CR in R&R areas of NQ.Setting: Four focus communities in R&R areas of NQ.Participants: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). Design:A qualitative descriptive case study, with data collection via semistructured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities.Results: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post-discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community-based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services. Conclusion:To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.

Commentary: Improving access to cardiac rehabilitation (Heart: Road for health) for Aboriginal and Torres Strait Islander peoples in rural and remote areas of North Queensland

“…Several recent research studies contribute to, and provide recommendations, for improving access and attendance to CR for people who live in R&R areas 8,9,14 . These studies include an integrative literature review that demonstrates a lack of understanding of CR, inflexible services, low referrals and attendance, 8 all underpinned by a weak systematic policy‐driven approach.…”

“…Also, referral rates to home‐based telephone support CR (Coaching on Achieving Cardiovascular Health [COACH]) were found to be low in NQ: 4%–20% 16 . To compound this, a community study on provision and access to CR in R&R areas of NQ demonstrated that Aboriginal and Torres Strait Islander peoples prefer face‐to‐face communication with someone they trust 9 . Also, the term CR was found to be confusing as it was linked to centre‐based care including gym, learning to walk poststroke, or hip replacement, or drug and alcohol programs 9 .…”

“…To compound this, a community study on provision and access to CR in R&R areas of NQ demonstrated that Aboriginal and Torres Strait Islander peoples prefer face‐to‐face communication with someone they trust 9 . Also, the term CR was found to be confusing as it was linked to centre‐based care including gym, learning to walk poststroke, or hip replacement, or drug and alcohol programs 9 . To improve clarity and understanding of CR, it is recommended that the term Heart: Road to health (HRH) is used 9 …”

“…Ideally, CR is provided through a holistic (health and well‐being), multidisciplinary approach that is delivered in a variety of settings, which includes hospital inpatient Phase‐1‐CR and outpatient Phase‐2‐CR 6 . Despite known benefits, CR referrals and attendance are low (30.2%), 7 predominantly due to inadequate Phase‐1‐CR 8 ; a scarcity of centre‐based services in R&R areas; inadequate culturally responsive care for Aboriginal and Torres Strait Islander people; and poor acceptance of telephone support programs 9,10 …”

“…Currently, on discharge from hospital, people with HD (clients) are usually advised to see their general practitioner (GP), or in areas serviced by Primary Health Care Centres (PHCC), to consult a clinic nurse. During this process, holistic multidisciplinary postdischarge care is compromised by a range of factors including: medical discharge summaries being delayed, predominantly clinical and rarely mentioning CR, holistic, multidisciplinary care or risk factor management 8 ; poor understanding of CR by health staff and clients 8,9 ; poor interhealth service communication 8 including non‐sharing of medical records by different health care organisations 9 ; use of predominantly western medical practices that are known to be ineffectual in treating Aboriginal and Torres Strait Islander people 13 …”