Cargando…

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

BACKGROUND: Cardiovascular 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...

Descripción completa

Detalles Bibliográficos
Autores principales: Hamilton, Sandra, Mills, Belynda, McRae, Shelley, Thompson, Sandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791246/
https://www.ncbi.nlm.nih.gov/pubmed/29382343
http://dx.doi.org/10.1186/s12913-018-2873-8
_version_ 1783296593754062848
author Hamilton, Sandra
Mills, Belynda
McRae, Shelley
Thompson, Sandra
author_facet Hamilton, Sandra
Mills, Belynda
McRae, Shelley
Thompson, Sandra
author_sort Hamilton, Sandra
collection PubMed
description BACKGROUND: Cardiovascular 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. METHODS: CR 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. RESULTS: Of 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. CONCLUSION: Geography, 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.
format Online
Article
Text
id pubmed-5791246
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-57912462018-02-08 Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia Hamilton, Sandra Mills, Belynda McRae, Shelley Thompson, Sandra BMC Health Serv Res Research Article BACKGROUND: Cardiovascular 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. METHODS: CR 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. RESULTS: Of 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. CONCLUSION: Geography, 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. BioMed Central 2018-01-30 /pmc/articles/PMC5791246/ /pubmed/29382343 http://dx.doi.org/10.1186/s12913-018-2873-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hamilton, Sandra
Mills, Belynda
McRae, Shelley
Thompson, Sandra
Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title_full Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title_fullStr Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title_full_unstemmed Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title_short Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia
title_sort evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote western australia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791246/
https://www.ncbi.nlm.nih.gov/pubmed/29382343
http://dx.doi.org/10.1186/s12913-018-2873-8
work_keys_str_mv AT hamiltonsandra evidencetoservicegapcardiacrehabilitationandsecondarypreventioninruralandremotewesternaustralia
AT millsbelynda evidencetoservicegapcardiacrehabilitationandsecondarypreventioninruralandremotewesternaustralia
AT mcraeshelley evidencetoservicegapcardiacrehabilitationandsecondarypreventioninruralandremotewesternaustralia
AT thompsonsandra evidencetoservicegapcardiacrehabilitationandsecondarypreventioninruralandremotewesternaustralia