Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups

Abstract

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The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence

“…In addition, the majority of previous economic analyses had a more intensive centre-based programme than are standard in the UK 28,29,31,95,97,98 and had less home visiting than was provided in this study. 100 Although the cost per patient in the centre-based arm in BRUM was lower than in the HTA survey 63 (£157 in BRUM versus £220 per patient referred), much of this difference is due to the BRUM centrebased costs including a narrower range of services and focusing on Phase III of the CR programme whereas the HTA survey included the whole CR service costs divided between the number of CR participants. This will include the phase one input to all patients, some Phase II home visiting programmes and some Phase IV continuation programmes.…”

“…63 Patient factors include work or domestic commitments, 20,39,64,65 a lack of interest in rehabilitation or a reluctance to change their lifestyle, [65][66][67] a dislike of groups, 68 patient depression, 55 living in a rural setting 50,69 and lack of support from the family. 54,65 Difficulties with accessibility of programmes and parking problems are commonly cited as a reason for poor adherence.…”

“…A recent Health Technology Assessment (HTA) report 63 based a detailed costing on the staffing mix of 30 UK CR programmes with estimates of the overheads, building capital and equipment costs included, using costs for 2000-1. This suggested an average staffing cost of £354 and a weighted total average cost to the health service of £486 per patient successfully completing the rehabilitation programme.…”

Exploring Uptake of Cardiac Rehabilitation in a Minority Ethnic Population in England: A Qualitative Study

“…A number of studies have found women are less likely to attend CR [14][15][16] but this may be related to women generally being older than men when they present with CHD and because they are also more likely to live alone [17]. In addition, there is some evidence that women tend to have poorer health and significant co-morbidity at presentation compared to men which may be a reason why women are less likely to be offered CR in the first instance [18]. A recent systematic review identifying studies which reported on interventions to improve uptake, adherence and professional compliance in cardiac rehabilitation by Beswick et al identified only two studies which reported interventions in ethnic groups [19]: one of these was a prospective study set in North America and the other was a programme description of a project in the UK providing translated educational material to South Asians.…”

Effects of cardiac rehabilitation referral strategies on referral and enrollment rates

“…although this method is not systematic and can be costprohibitive, it is informative to patients and promotes Cr endorsement. 26 there are two published reviews that have examined multiple Cr utilization interventions and their effects on Cr enrollment and adherence, 45,46 but neither investigated effects on Cr referral rates. moreover, the effect of referral strategies on Cr utilization has not been specifically reviewed.…”