A Survey of Accessibility to Australia’s
Phase 2 Cardiac Rehabilitation Programs
Dr. Deborah van Gaans
Centre for Research Excellence in the Prevention of Chronic Conditions in Rural and Remote Populations
School of Population Health
The research reported in this presentation has been supported by the Australian Primary Health Care
Research Institute, which is supported by a grant from the Commonwealth of Australia as
represented by the Department of Health and Ageing. The information and opinions contained in it
do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute
or the Commonwealth of Australia (or the Department of Health and Ageing).
An Australian Research Council Funded Linkage
Project with the Following Collaborating Partners :
The University of Adelaide - Mr. Neil Coffee
Alphapharm Pty Ltd. - Mr. Peter Astles, Ms. Marian Milligan
University of South Australia - Dr. Robyn Clark
University of Queensland - Professor David Wilkinson, Dr. Kerena Eckert
Monash University - Professor Andrew Tonkin
The Baker Heart Research Institute - Professor Simon Stewart
Background
Cardiac Event
Cath Lab
Local hospital
GP
Phone
Ambulance
Cardiac
Speciality Area
Home
Transplant
Cardiac Rehabilitation
1.Introduced into Australia by the National Heart
Foundation in 1961.
2.By 1986, cardiac rehabilitation had advanced sufficiently
for it to be seen as an important component of cardiac
care.
3.Defined benefits include reduced mortality and reduced
risk of further cardiac events; improvements in physical
and social functioning, risk factor profiles and quality of life;
and reduced prevalence of depression
Source: Bunker, S,J, and Goble, A, J 2003, ‘Cardiac rehabilitation: under-referral and
underutilisation’, MJA 2003; 179 (7): 332-333
Method
Cardiac Rehabilitation Accessibility
Survey
Postal survey of all cardiac
rehabilitation services
(n=401)
Completed surveys (n= 204)
Services that did not run a
Phase 2 Cardiac
Rehabilitation Program
(n= 158)
No reply (n= 39)
No time to fill out the
survey (n= 28)
Services that did not run a
Phase 2 Cardiac
Rehabilitation Program
(n= 9)
No reply (n= 2)
Results
The Cardiac Rehabilitation Accessibility Survey found the following:
•
73% Phase 2 Cardiac Rehabilitation Programs in Australia require patients to
have a referral prior to patients accessing their program.
•
All Phase 2 Cardiac Rehabilitation Programs in Australia were each run with very
limited and specific hours of operation, with some programs operating as little as
2 hours a week.
•
Only 2% of the Phase 2 Cardiac Rehabilitation Programs ran out of hours
sessions for patients.
Results
The Cardiac Rehabilitation Accessibility Survey found the following:
•
The Cardiac Rehabilitation Accessibility Survey found that more than half (56%,
n=228) of the Phase 2 Cardiac Rehabilitation Programs Surveyed conducted
both group and individual sessions.
•
Group only sessions were conducted by 36.8% of
the total number of Phase 2 Cardiac Rehabilitation
Programs in Australia.
•
Individual only sessions were run by only 6.6% of
the Phase 2 Cardiac Rehabilitation Programs
surveyed.
Results
The Cardiac Rehabilitation Accessibility Survey found the following:
•
49% of Phase 2 Cardiac Rehabilitation Programs had all 6 recommended
components the National Heart Foundations’ Recommended Framework (2004).
•
The percentage of Cardiac Rehabilitation Programs with components
recommended by the NHF:
Health education
96%
Physical activity
96%
Counselling
80%
Behaviour modification strategies
84%
Support for self-management
90%
Cultural understanding
62%
Source: National Heart Foundation and Australian Cardiac Rehabilitation Association, 2004, Recommended
Framework for Cardiac Rehabilitation ’04, National Heart Foundation, Melbourne, Victoria.
Results
•
Results from the Cardiac Rehabilitation
Accessibility Survey show that 68% of Phase
2 Cardiac Rehabilitation Programs in Australia
accept all age groups into their programs.
•
Of the 32% that did not accept all age groups
into their programs all most all accepted
patients from 35 to 85 years and older into
their programs.
Results
•
Results from the Cardiac
Rehabilitation Accessibility Survey,
reveal that completion rates of
Phase 2 Cardiac Rehabilitation
Programs are low with only 14 %
of programs having 100% of
patients complete their program.
The survey also revealed that 18%
of Phase 2 Cardiac Programs had
half or less of their patients
complete the program.
Unknown
Percentage of Patient Completions
•
100%
90 - 99%
80 - 89%
70 - 79%
51- 69%
1- 50%
0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Percentage of Phase 2 Cardiac Rehabilitation Programs
18%
Results
The National Heart Foundation identified the following core group of people
who are eligible for cardiac rehabilitation:
•
•
•
•
•
Myocardial infarction (ST elevation MI, non-ST elevation MI)
Re-vascularisation procedures
Stable or unstable angina
Controlled heart failure
Other vascular or heart disease
Source: National Heart Foundation and Australian Cardiac Rehabilitation Association, 2004, Recommended
Framework for Cardiac Rehabilitation ’04, National Heart Foundation, Melbourne, Victoria.
Results
Discharge Diagnosis Accepted
into Phase 2 Cardiac
Rehabilitation Programs.
Results
Postal
Internet
12%
3%
Home visits
52% of Phase 2 Cardiac Rehabilitation
Programs operate out of an acute public
hospital.
•
Programs offering alternative modes of
delivery such as: telephone service
(28%), home visits (25%), postal (12%)
and internet (3%), are limited.
25%
Telephone service
28%
As part of an outreach service to communities
Setting
•
8%
Within a private outpatient service
3%
Within a public community health centre/service
33%
Within a non-acute/community hospital
7%
Within an Aboriginal medical service
2%
Within an acute private hospital
8%
Within an acute public hospital
52%
0%
10%
20%
30%
40%
50%
Percentage of Phase 2 Cardiac RehabilitationPrograms
60%
Results
•
The Cardiac Rehabilitation Accessibility
Survey revealed that only 23% of Phase
2 Cardiac Rehabilitation Programs in
Australia are provided to the patient as a
free service.
•
Schemes to make the Phase 2 Cardiac
Rehabilitation Programs accessible to
poorer patients such as Medicare (59%),
Centrelink (56%), Health Card (57%) and
Department of Veteran Affairs Cards
(70%) were not accepted at all programs.
•
Extra costs were also identified through
the survey which ranged from a gold coin
donation per session to $60 per session.
Conclusion
•
Results from the Cardiac Rehabilitation Accessibility Survey show that
patient accessibility to Phase 2 Cardiac Rehabilitation Programs extends
beyond service availability and includes various impediments that can
prevent or limit service use.
•
The Cardiac Rehabilitation Accessibility Survey highlighted that the need
for a referral, the cardiac disease the patient has, the provision of group
and individual sessions, flexibility in service delivery setting, hours of
operation, cost, and range of program components as significant barriers
imposed by Phase 2 Cardiac Rehabilitation Programs that limit patient
accessibility.
•
While patient barriers to cardiac rehabilitation are well documented,
program barriers need to be considered by service providers when
providing a Phase 2 Cardiac Rehabilitation Program, to improve
accessibility.
Dr. Deborah van Gaans
Centre for Research Excellence in the Prevention of Chronic Conditions in Rural and Remote Populations
School of Population Health
Email: Deborah.vangaans@unisa.edu.au