Background: Little is known about the predictive role of Cardiac Self Efficacy (CSE) in the ensuing months following a coronary event. We sought to determine whether CSE predicts adverse events in the months following discharge in patients with Coronary Artery Disease (CAD). Design: Data from a prospective study of 193 patients recently hospitalized for CAD. Methods: Data were collected via participant self-report and medical records at 3-month post-discharge (baseline; T1), 6-month post-discharge (T2) and 9-month post-discharge (T3). CSE was measured using the Cardiac Self Efficacy Scale. Multi-variate regression modeling was applied to explore the association between baseline CSE scores and cardiac-related hospital admissions and functional cardiac status at T2 and T3. Other outcomes included any hospital admissions, self-reported mental and physical health at follow up. Results: Higher CSE scores at baseline significantly predicted better cardiac functioning and self-rated mental and physical health at both T2 and T3 (with one exception); this was consistent across all five models. While baseline CSE did not predict cardiac or other hospital admission at T2, CSE was a significant predictor of both outcomes at T3; higher CSE scores resulted in reductions in likelihood of hospital admissions. After adjustment for psychosocial variables however, neither association remained. Baseline depression explained the association between baseline CSE and any cardiac admissions, as well as baseline CSE and any hospital admissions at T3 follow up. Conclusions: While CSE can predict key outcomes following a CAD event, much of the association can be explained by the presence of depression.

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A study of an intensive home-based treatment program and its impact on admissions in an aged-care setting eral practitioner care to individually tailored community nursing interventions in the primary care setting also found the latter to be more effective for elderly people with depression. 8 In an elderly disabled population, community psychiatric treatment was found to be more effective than GP care alone in the treatment of depression. 9 The Barwon Health Aged Psychiatry Service The Aged Psychiatry Service (APS) is a community based multidisciplinary psychiatric service that serves approximately 37,000 people over the age of 65 within the Geelong and Colac regions of Victoria (Australia), a catchment area of a quarter of a million people. The target population are those with significant psychiatric disorder or with dementia with severe behavioural or psychiatric symptoms. A typical community service response includes assessment followed by advice, education, treatment, brief supportive therapy or case management, and this usually occurs in collaboration with the treating GP. All patients are case managed who require a full assessment by APS. The APS was established in 1996 with one half time psychiatrist and two community psychiatric nurses, and over the past nine years has grown to a team with two half time psychiatrists, one psychiatric registrar and ten community case managers together with administration staff and a team coordinator. The APS has only had access to four acute psychiatric inpatient beds situated within an acute general adult psychiatric unit, but staff have long recognized that for nursing the frail elderly, this environment is not ideal. Because of the low number of beds and the inappropriateness of the environment for the elderly it has been necessary, even before the introduction of the intensive house based programme (IHBP),

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