Cardiac Rehabilitation (CR) reduces mortality for heart disease – the largest single cause of death in Australia – by 20 to 30 per cent. It improves quality of life and halves hospital readmissions, saving the national health budget an estimated $100 million annually. In regions with a higher incidence of cardiac disease, such as North Queensland, hospitals must maximise every opportunity to help patients forge a road to recovery.
A JCU study has identified ways to improve the delivery of cardiac rehabilitation to hospital in-patients in regional north Queensland, where skills to continue recovery, independently, following discharge, are crucial in areas with limited access to on-ground rehab services.
PhD student, Ms Patricia Field, spoke with cardiac unit in-patients and staff in four tertiary hospitals (two public and two private) in the region to explore new pathways to implement Phase-1 cardiac rehabilitation (Phase-1-CR).
Phase-1-CR provides crucial in-patient education, discharge planning and referral to outpatient Phase-2-CR services, such as dieticians, physiotherapists and social workers, to help patients maximise their recovery. It includes the provision of culturally appropriate services for Aboriginal and Torres Strait Islander patients, who are at even higher risk of severe disease impacts.
Ms Field conducted a total of 96 interviews with patients and hospital staff, and also undertook a medical record audit of randomly selected case notes for 340 adult in-patients treated for heart disease in 2017.
The study findings prompted her to recommend upskilling of direct care staff in hospitals, through provision of regular in-service education and online learning, to expand opportunities to deliver key Phase-1-CR messages to in-patients, as well as facilitate referral to Phase-2-CR services.
“This would equip staff to integrate messages about cardiac rehabilitation into their everyday care of patients,” said Ms Field. “Participation by medical staff is particularly important in this process, as earlier studies have demonstrated that if doctors recommended Phase-2-CR, patients were more likely to attend.”
Direct care hospital staff surveyed in the study also advocated the introduction of practical tools, such as checklists, to assist them to prepare patients for discharge, as well as ready access to the National Heart Foundation’s My Heart, My Life booklet (MHML).
Both MHML and Queensland Health’s Coaching on Achieving Cardiovascular Health (COACH) program offer phone-based Phase-2-CR services.
Referral to these services, as well as local GPs, Aboriginal and Torres Strait Islander Health Services, Primary Health Care Centres and community nurses, could be generated automatically for discharging patients in public hospitals, through integration of the Queensland Health Coronary Outcomes Register and integrated electronic medical records.
Ms Field said there was a strong need to improve communication between hospitals and Phase-2-CR providers to ensure holistic ongoing care and support for cardiac disease patients.
“It is essential for effective cardiac rehabilitation in rural and remote areas of North Queensland, that systems of health care, communication and pathways, from hospital to home, are revised. To achieve this, our research team continues to work with health services to develop strategies for improvement.”