The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of ...cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council’s designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual’s risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.
We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to ...increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases.We hypothesise that a model of care co-designed with stakeholders will address patients' needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service.The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study.
IntroductionDespite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%–50% of eligible patients participating. We ...aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants.Methods and analysisCHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation.Ethics and disseminationThis study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request.Trial registration numberACTRN12621000222842.
To measure the prevalence of overweight, obesity and the metabolic syndrome (MetS) in rural Australia.
Cross-sectional surveys were conducted in two rural areas in Victoria and South Australia in ...2004-2005. A stratified random sample of men and women aged 25-74 years was selected from the electoral roll. Data were collected by a self-administered questionnaire, physical measurements and laboratory tests.
Prevalence of overweight and obesity, as defined by body mass index (BMI) and waist circumference; prevalence of MetS and its components.
Data on 806 participants (383 men and 423 women) were analysed. Based on BMI, the prevalence of overweight and obesity combined was 74.1% (95% CI, 69.7%-78.5%) in men and 64.1% (95% CI, 59.5%-68.7%) in women. Based on waist circumference, the prevalence of overweight and obesity was higher in women (72.4%; 95% CI, 68.1%-76.7%) than men (61.9%; 95% CI, 57.0%-66.8%). The overall prevalence of obesity was 30.0% (95% CI, 26.8%-33.2%) based on BMI (> or = 30.0 kg/m(2)) and 44.7% (95% CI, 41.2%-48.1%) based on waist circumference (> or = 102 cm men and > or= 88 cm women). The prevalence of MetS as defined by the US National Cholesterol Education Program Adult Treatment Panel III 2005 criteria was 27.1% (95% CI, 22.7%-31.6%) in men and 28.3% (95% CI, 24.0%-32.6%) in women; based on International Diabetes Federation criteria, prevalences for men and women were 33.7% (95% CI, 29.0%-38.5%) and 30.1% (95% CI, 25.7%-34.5%), respectively. Prevalences of MetS, central (abdominal) obesity, hyperglycaemia, hypertension and hypertriglyceridaemia increased with age.
In rural Australia, prevalences of MetS, overweight and obesity are very high. Urgent population-wide action is required to tackle the problem.
Background Interventions that facilitate access to cardiac rehabilitation and secondary prevention programs are in demand. Methods This pilot study used a mixed methods design to evaluate the ...feasibility of an Internet-based, electronic Outpatient Cardiac Rehabilitation (eOCR). Patients who had suffered a cardiac event and their case managers were recruited from rural primary practices. Feasibility was evaluated in terms of the number of patients enrolled and patient and case manager engagement with the eOCR website. Results Four rural general practices, 16 health professionals (cardiologists, general practitioners, nurses and allied health) and 24 patients participated in the project and 11 (46%) completed the program. Utilisation of the website during the 105 day evaluation period by participating health professionals was moderate to low (mean of 8.25 logins, range 0–28 logins). The mean login rate for patients was 16 (range 1–77 logins), mean time from first login to last (days using the website) was 51 (range 1–105 days). Each patient monitored at least five risk factors and read at least one of the secondary prevention articles. There was low utilisation of other tools such as weekly workbooks and discussion boards. Conclusions It was important to evaluate how an eOCR website would be used within an existing healthcare setting. These results will help to guide the implementation of future internet based cardiac rehabilitation programs considering barriers such as access and appropriate target groups of participants.
PoCT is an important enabler of evidence-based cardiac care allowing safe risk stratification and management of patients across country hospitals. Success of a large network relies on good ...communication, user-friendly instructions, effective IT, flexible training programs and good support systems.
The Integrated Cardiovascular Clinical Network Country Health SA (iCCnet CHSA) provides face to face and videoconferencing training, online education and competencies for PoCT operators. Online resources are located on the iCCnet CHSA website (www.iccnetsa.org.au) and 24/7 technical support is provided to PoCT operators.
iCC net CHSA supports PoCT across country hospitals in South Australia. PoCT is managed by clinical network scientists complying with recommendations set by professional organisations such as the Australasian Association of Clinical Biochemists. They ensure all hospitals are involved in quality programs and have access to training when required. Because of staff resources across country, a variety of options for training PoCT operators are provided, ensuring it is accessible to all staff when convenient.
iCCnet CHSA removes the barriers to access education, training and support to allow the operation of PoCT within a quality framework in the management of cardiovascular disease. PoCT has been integral component to the improved cardiac outcomes reported by iCCnet CHSA.
Centre-based cardiac rehabilitation (CR) programs were disrupted and urged to adopt telehealth modes of delivery during the COVID-19 public health emergency. Previously established telehealth ...services may have faced increased demand. This study aimed to investigate a) the impact of the COVID-19 pandemic on CR attendance/completion, b) clinical outcomes of patients with cardiovascular (CV) diseases referred to CR and, c) how regional and rural centre-based services converted to a telehealth delivery during this time.
A cohort of patients living in regional and rural Australia, referred to an established telehealth-based or centre-based CR services during COVID-19 first wave, were prospectively followed-up, for ≥90 days (February to June 2020). Cardiac rehabilitation attendance/completion and a composite of CV re-admissions and deaths were compared to a historical control group referred in the same period in 2019. The impact of mode of delivery (established telehealth service versus centre-based CR) was analysed through a competitive risk model. The adaption of centre-based CR services to telehealth was assessed via a cross-sectional survey.
1,954 patients (1,032 referred during COVID-19 and 922 pre-COVID-19) were followed-up for 161 (interquartile range 123–202) days. Mean age was 68 (standard deviation 13) years and 68% were male. Referrals to the established telehealth program did not differ during (24%) and pre-COVID-19 (23%). Although all 10 centre-based services surveyed adopted telehealth, attendance (46.6% vs 59.9%; p<0.001) and completion (42.4% vs 75.4%; p<0.001) was significantly lower during COVID-19. Referral during vs pre-COVID-19 (sub hazard ratio SHR 0.77; 95% CI 0.68–0.87), and to a centre-based program compared to the established telehealth service (SHR 0.66; 95% CI 0.58–0.76) decreased the likelihood of CR uptake.
An established telehealth service and rapid adoption of telehealth by centre-based programs enabled access to CR in regional and rural Australia during COVID-19. However, further development of the newly implemented telehealth models is needed to promote CR attendance and completion.
Person-centred care advocates for co-design of all healthcare services and research interventions by the end-user. Co-design is widely used, but the methodological approaches, evaluation, and ...reporting of outcomes are often poorly defined. One methodology for co-design is the User Experience Design which provides guidance and theoretical frameworks to inform development and reporting measures. This article outlines the application of this approach in the development of a web-based cardiac rehabilitation program and reports on the very positive experiences of the patients involved in the process and how their input strategically influenced outcomes.
Many countries in Europe have routinely implemented the use of point-of-care testing (POCT) for c-reactive protein (CRP) in primary care to guide antibiotic therapy in patients with acute respiratory ...infections; however, this has not been implemented in the UK or Australia. General practice is where the majority of antibiotics are prescribed and CRP testing may provide a means to help limit antibiotic use to those patients with severe (bacterial) infections. A recent addition to this debate is whether the arguments to measure CRP rapidly also need to be applied to COVID-19 testing. The clinical evidence to support CRP POCT to guide antibiotic therapy in adult patients was recently reviewed by Cals and Ebeii. They concluded that in adults there is accumulating evidence that CRP use can help safely reduce antibiotic usage in patients with acute respiratory infections. A recent narrative review by Cooke et al queried why the test is not more widely used in the UK. Given the extent of the evidence base, the issue becomes one of identifying the remaining barriers to implementation and how they can be addressed.
Objectives. To describe the development and evaluation of an accreditation program for Point of Care Testing (PoCT) in general practice, which was part of the PoCT in general practice (GP) Trial ...conducted in 2005-07 and funded by the Australian Government. Setting and participants. Thirty general practices based in urban, rural and remote locations across South Australia, New South Wales and Victoria, which were in the intervention arm of the PoCT Trial were part of the accreditation program. A PoCT accreditation working party was established to develop an appropriate accreditation program for PoCT in GP. A multidisciplinary accreditation team was formed consisting of a medical scientist, a general practitioner or practice manager, and a trial team representative. Methodology and sequence of events. To enable practices to prepare for accreditation a checklist was developed describing details of the accreditation visit. A guide for surveyors was also developed to assist with accreditation visits. Descriptive analysis of the results of the accreditation process was undertaken. Outcomes. Evaluation of the accreditation model found that both the surveyors and practice staff found the process straightforward and clear. All practices (i.e. 100%) achieved second-round accreditation. Discussion and lessons learned. The accreditation process highlighted the importance of ongoing education and support for practices performing PoCT.
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