Heart disease continues to be a major cause of death and disability in Australia, but treatment has improved, and support to assist people with heart disease (clients) to achieve best possible health and lifestyle, as well as slow or prevent progression of heart disease, is available through cardiac rehabilitation (CR) when they return home for hospital. However, clients rarely access CR in rural and remote areas.
To address these issues, James Cook University, (JCU) PhD student, Patricia Field, supported by a team of JCU academics, undertook extensive qualitative research in North Queensland (NQ). During this research, she undertook in-depth interviews of clients and health staff in four communities in NQ. Her research found that access and understanding of CR was poor, and even if available, clients may be uncomfortable attending group or gym sessions, or thought that ‘rehab’ was connected with drug and alcohol programs. Further, it was clear that there is a need for greater flexibility through local community-based programs. As such, the innovative Heart: Road to Health (HRH) model, has been developed as an alternative CR model of care in rural and remote areas. Central to the reform are local community nurses, Aboriginal and Torres Strait Islander Health Workers and allied health professions, who would be supported by guidelines and education to ensure a holistic client-centred approach to enhance their recovery.
Effective utilisation of existing resources should aid cost-effectiveness of the model. The research included a health service audit which found most populated areas of North Queensland already had access to community-based or visiting health care services, including Aboriginal and Torres Strait Islander Health Workers, nurses, allied health professionals and medical staff.
Research participants suggested access to CR and post-discharge care could be improved through increased referrals and better communication from the treating hospital and better co-ordination of local services, as well as the provision of guidelines to ensure that all staff were mindful of, and have the skills to provide, holistic health care plans, both in hospital and on return to the patients’ home community.
“There are already examples of effective community-based programs that provide holistic, patient-centred care, such as the diabetes model of education and self-management, and community-based post-natal care,” Pat observed.
“HRH could be implemented through a similar community-based system, which would include initial assessment, coordination and referral of community-based/visiting health care providers for ongoing health care, risk factor management and psycho-social support, augmented by telehealth and telephone CR.”
Successful adoption of the new model would be underpinned by guidelines and ongoing education for the health workforce – essential in rural and remote areas, where staff turnover is high.
Ms Field believes Heart: Road to Health could assist heart disease patients to continue their journey towards optimal recovery – and also provide a useful template for the secondary prevention of other chronic diseases.
