Importance of cardiac rehabilitation in rural and remote areas of Australia

Abstract

Objective To assess implementation of in‐patient cardiac rehabilitation (Phase‐1‐cardiac rehabilitation), impact on people in rural and remote areas of Australia and potential methods for addressing identified weaknesses. Design Exploratory case study methodology using qualitative and quantitative methods. Qualitative data collection via semi‐structured interviews, using thematic analysis, augmented by quantitative data collection via a medical record audit. Setting Four regional hospitals (2 Queensland Health and 2 private) providing tertiary health care. Participants (a) Hospital in‐patients with heart disease ≥18 years. (b) Staff responsible for their care. Outcome Measures Implementation of Phase‐1‐cardiac rehabilitation in tertiary hosptials in North Queensland and the impact on in‐patients discharge planning and post discharge care. Recommentations and implications for practice are proposed to address deficits. Results Phase‐1‐cardiac rehabilitation implementation rates, in‐patient understanding and multidisciplinary team involvement were low. The highest rates of Phase‐1‐cardiac rehabilitation were for in‐patients with a length of stay three days or more in cardiac units with cardiac educators. Rates were lower in cardiac units with no cardiac educators, and lowest for in‐patients in all areas of all hospitals with length of stay of two days or less days. Low Phase‐1‐cardiac rehabilitation implementation rates resulted in poor in‐patient understanding about their disease, treatment and post‐discharge care. Further, medical discharge summaries rarely mentioned cardiac rehabilitation/secondary prevention or risk factor management resulting in a lack of information for health care providers on cardiac rehabilitation and holistic health care. Conclusion Implementation of Phase‐1‐cardiac rehabilitation in regional hospitals in this study fell short of recommended best practice, resulting in patients' poor preparation for discharge, and insufficient information on holistic care for health care providers in rural and remote areas. These factors potentially impact on holistic care for people returning home following treatment for heart disease.

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

“…[S4/4, S3/4, S19/1] AHP reduced ability to be utilised to their full potential, which is also reflected previous research that described AHP’s diminished role in holistic health care, and SP 41,42 . Further, post‐discharge care for people with HD was found to be predominantly clinical,[2/2] with medical discharge summaries often delayed and rarely mentioning CR or risk factor management,[S2/2] confirming findings of a previous Phase‐1‐CR implementation study 27 …”

“…[CN1/2&2/2] Health systems' weaknesses further impacted on Phase-2-CR attendance, including inadequate implementation of Phase-1-CR, in tertiary hospitals in NQ. 27 This shortfall resulted in patients' poor understanding of their disease, post-discharge care and low referrals to Phase-2-CR. 27 QH Chronic Disease Manual recommends referral to CR or local health services to ensure continuity of care for all people with stable HD, 43 but no evidence of implementation of this recommendation, including guidelines or pathways, were found.…”

“…27 This shortfall resulted in patients' poor understanding of their disease, post-discharge care and low referrals to Phase-2-CR. 27 QH Chronic Disease Manual recommends referral to CR or local health services to ensure continuity of care for all people with stable HD, 43 but no evidence of implementation of this recommendation, including guidelines or pathways, were found. [QHCN4 /1] To improve access to CR in R&R areas, a multifaceted systems approach that includes pathways and guidelines is required.…”

“…22 The initial direction and framework of the study were guided by the findings of (i) an integrative literature review on barriers, enablers and pathways to CR in R&R areas 25 ; (ii) a demographic study of hospitalisations for HD and referrals to COACH in NQ 26 and (iii) a case study on implementation of Phase-1-CR in tertiary hospitals in NQ and impact in R&R areas. 27 Drawing on this research, deductive analysis was used to identify primary themes/areas of interest, together with the development of semi-structured interview guidelines (Appendix S2 and S3) for data collection via purposeful information rich samples. 28 Participants were defined by:…”

“…Descriptive case study methodology 22 was used, with a qualitative interpretive framework 23 . This approach was suitable for multiple sites 24 and allowed for the description of ‘an intervention or phenomenon in a real‐life context’ (the case), in order to ‘develop theory, evaluate programs and develop interventions.’ 22 The initial direction and framework of the study were guided by the findings of (i) an integrative literature review on barriers, enablers and pathways to CR in R&R areas 25 ; (ii) a demographic study of hospitalisations for HD and referrals to COACH in NQ 26 and (iii) a case study on implementation of Phase‐1‐CR in tertiary hospitals in NQ and impact in R&R areas 27 . Drawing on this research, deductive analysis was used to identify primary themes/areas of interest, together with the development of semi‐structured interview guidelines (Appendix ) for data collection via purposeful information rich samples 28…”