Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia

Abstract

BackgroundCardiovascular disease (CVD), a leading cause of morbidity and mortality, has similar incidence in metropolitan and rural areas but poorer cardiovascular outcomes for residents living in rural and remote Australia. Cardiac Rehabilitation (CR) is an evidence-based intervention that helps reduce subsequent cardiovascular events and rehospitalisation. Unfortunately CR attendance rates are as low as 10–30% with rural/remote populations under-represented. This in-depth assessment investigated the provision of CR and secondary prevention services in Western Australia (WA) with a focus on rural and remote populations.MethodsCR and Aboriginal Community Controlled Health Services were identified through the Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Structured interviews with CR coordinators included questions specific to program delivery, content, referral and attendance.ResultsOf the 38 CR services identified, 23 (61%) were located in rural (n = 11, 29%) and remote (n = 12, 32%) regions. Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) found 77% of rural/remote services were hospital-based, with no service providing a comprehensive home-based or alternative method of program delivery. The majority of rural (60%) and remote (80%) services provided CR through chronic condition exercise programs compared with 17% of metropolitan services; only 27% of rural/remote programs provided education classes. Rural/remote coordinators were overwhelmingly physiotherapists, and only 50% of rural and 33% of remote programs had face-to-face access to multidisciplinary support. Patient referral and attendance rates differed greatly across WA and referrals to rural/remote services generally numbered less than 5 per month. Program evaluation was reported by 33% of rural/remote coordinators.ConclusionGeography, population density and service availability limits patient access to CR services in rural/remote WA. Current inadequacies in delivering comprehensive centre-based CR in rural/remote settings impedes management of cardiovascular risk and opportunities for event reduction. Health pathways that ensure referral and continuity of care are needed, with emerging technology-based CR support to supplement centre-based CR services requiring assessment. Implementing systematic data collection across services to establish benchmarks and enable service monitoring and evaluation is needed.

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

“…One study found that more than 70% of Aboriginal patients with AF and CHA 2 DS 2 ‐VASc scores of 2 or more were not receiving oral anticoagulants . Warfarin was the main oral anticoagulant available during our study period, but adequate monitoring of patients’ international normalised ratio (INR) in rural and remote communities is difficult because of remoteness, limitations in service availability and culturally appropriate referral pathways, and family caring responsibilities. Recent Australian guidelines recommend novel oral anticoagulants (NOACs) for Aboriginal people with non‐valvular AF because they overcome many of the logistic and clinical barriers associated with warfarin .…”

Association between happiness and psychopathology in an elderly regional rural population in Crete

“…Such studies on mental health in the elderly population in rural and remote regions are of utmost importance, considering the special characteristics of these areas, such as low population density with small settlements and poor accessibility to healthcare services. 3 Research suggests that several factors have an impact on mental health in the elderly. Marriage and a close social network have been positively associated with psychological well-being and happiness, [4][5][6][7] whereas low socio-economic status, stressful life events, and living alone 8 have been identified as risk factors for the development of psychopathological symptoms.…”

“…3 Research suggests that several factors have an impact on mental health in the elderly. Marriage and a close social network have been positively associated with psychological well-being and happiness, [4][5][6][7] whereas low socio-economic status, stressful life events, and living alone 8 have been identified as risk factors for the development of psychopathological symptoms. 9,10 Moreover, smoking and alcohol consumption have been reported to correspond with increased levels of depression in elderly people.…”

Development and validation of continuity measures for inpatients receiving rehabilitation care

“…[1,2] Despite the recent policy focus on maintain and enhance continuity of care (COC) within hospital care, [3] rehabilitation research reports that there is limited communication, transfers delays and administrative barriers between rehabilitation team and other services. [1,4,5] Inpatients receiving physiotherapy report a lack of transfer of information and consistency of care between professionals. These concerns are related to content, synchronization, or sequence of the physiotherapy activities.…”

“…These measures have examined features of the chronology of sequential care or transfers delays. [2,4,5,7,8,13,14] Likely, continuity from patient's perspective is not often evaluated because of the lack of an agreed definition and suitable measurement tools.…”