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Background Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients. Methods We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. Results The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. Conclusion The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
Background Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients. Methods We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. Results The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. Conclusion The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
Background: A cardiac rehabilitation program (CRP) is an interdisciplinary intervention that combines the medical, social, and educational components necessary for cardiac rehabilitation so that people with cardiovascular disease can regain their functional abilities and improve their quality of life. In CRP, nurses have an essential role in patient care and service coordination. The basic components of a CRP that can be adapted remain unknown, as there are many different CRP. This study aims to identify the key features of a CRP that can inform public policy. Currently, there is no synthesis of the characteristics of services in CRP that can be adapted in the literature. This study aims to identify the main characteristics of cardiac rehabilitation programs nurses offer when providing cardiac rehabilitation after a myocardial infarction. Methods: A scoping study was conducted according to Arksey and O'Malley (2005). We systematically searched CINAHL, MEDLINE, Scopus, and Cochrane. Only empirical studies published between 2005 and 2022 with a CRP involving a nurse were included. CRP characteristics were classified, coded, and validated with the research team and categorized for analysis. Results: Fifteen articles were included in which 15 rehabilitation programs were identified. In total, four programs were offered, individualized nurse follow-up (n = 8), CRP solicitation (n = 2), use of technology (n = 3), and telehealth (n = 1). Overall, the features were categorized into four program types: 1) Interventions promoting early recruitment of participants; 2) Interventions promoting technology use; 3) Interventions based on multiple components; and 4) Interventions based on surveillance and monitoring activities. Conclusion: With the increase in myocardial infarctions, more and more patients need CRP. Nurse monitoring during CRP can be offered with several components to facilitate follow-up. These different follow-up components allow the nurse to anticipate care issues and obstacles the patient may encounter throughout cardiac rehabilitation. These elements should be promoted for engagement and participation in CR to improve CR provision. Finally, the characteristics of this study will support the conceptualization of a CR program.
Background: Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, cardiac rehabilitation programs are offered inequitably across regions, and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas, in order to improve the service offer for patients. Methods: We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes in two remote regions with knowledge users. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We used the guidelines of an operational model specific to cardiac rehabilitation to conceptualize data collection for the development of the cardiac rehabilitation program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. Results: The co-design process led to the development of a prototype cardiac rehabilitation program that is similar in both regions, based on a six-phase care and service trajectory contextualized to remote regions. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. Conclusion: The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
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