Improving access to cardiac rehabilitation for remote Indigenous clients

Abstract

Objective: To identify barriers to Indigenous patients taking up a rural general practice‐based cardiac rehabilitation program. We investigated the accessibility and appropriateness of the program and the role of Indigenous health workers (IHWs) in caring for Indigenous cardiac patients. Methods: A cross‐sectional survey of knowledge and views relating to cardiac rehabilitation was undertaken with 47 Indigenous cardiac patients and 41 health professionals in remote Queensland. Results: Only three patients were fully engaged in the program. Reasons for non‐participation included: lack of knowledge about rehabilitation, low income, and having a large extended family. Although the program incorporated a training component for IHWs covering prevention and follow‐up, most did not monitor patients specifically for their heart problems and thought they did not have adequate skills. Shared care was occurring in some settings but without the participation of IHWs. Conclusions: There was general agreement that IHWs do have a role in cardiac rehabilitation. There is a need for ongoing in‐service education or inclusion in training programs. Lack of understanding of the role of IHWs is a barrier to shared care. Cardiovascular disease needs to be addressed as part of the raft of chronic illnesses. Implications: Training about chronic illnesses and their management needs to be linked to structural adaptations in the delivery of health services to allow efficient use of each professional's skills. Clear role delineation needs to be negotiated to allow all health professionals to carry out their job effectively.

Build it and they will come: outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service

“…2 Cardiac rehabilitation is a clear example. Although a variety of models exist, 3 Aboriginal people are underrepresented in cardiac rehabilitation programs 4 and therefore forego the well-documented benefits, including reduced all-cause mortality, 5,6 reduced recurrent cardiac events 7 and improved quality of life. 8 To help address this service gap, a cardiac rehabilitation program was established in a metropolitan Aboriginal Medical Service (AMS) and its uptake, impact on health management behaviour and cardiovascular risk factors were documented.…”

Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology

“…30 The ambiguity of the role has been particularly highlighted in hospital settings, where the opportunities for AHWs to use their clinical skills are limited. Confusion of the role of an AHW can prevent effective shared care, 8 create discomfort both for the AHW and for staff working alongside them, and can undermine the role' s importance.…”

“…3 However, despite being twice as likely to die from CVD, 6 Aboriginal people are less likely to participate in CR than non-Aboriginal Australians. 7,8 In the hospital setting, a significant opportunity exists to inform Aboriginal patients about cardiac health and post discharge CR programs. However for many Aboriginal patients, communication barriers and a cultural mismatch with the hospital setting can leave them anxious, and unable to understand hospital procedures or fully engage with health information.…”

The development of a spatial model of accessibility to phase 2 cardiac rehabilitation programs

“…'Reasons for not participating include lack of time, lack of referral or physician support, financial reasons, lack of motivation, perceptions of the benefits, distance and transportation, family composition, nature of the program and work commitments. ' Shepherd et al (2003).…”