Program resources and impact in Australia Robyn Gallagher Marta Supervia Karam TurkAdawi Dion Candelaria Laila Ladak Lis Neubeck Sherry Grace Efficacy of cardiac rehabilitation Review Population ID: 759460
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Slide1
The Global Cardiac Rehabilitation Survey: Program resources and impact in Australia
Robyn GallagherMarta SuperviaKaram Turk-AdawiDion CandelariaLaila LadakLis NeubeckSherry Grace
Slide2Efficacy of cardiac rehabilitation
Review
Population
Intervention
Outcome
Anderson
et al., 2016
Cochrane Library
Coronary heart disease
Exercise-training
alone or in combination
Comparison usual care
12 months
26%
reduction in
Cardiovascular
Mortality
18%
reduction in
Hospital Admissions
Cost-effective
Van
Halewjin
et al., 2017
Int
J Cardio
Coronary heart disease ≥ 50%
Cardiac
rehabilitation and secondary prevention (face-to-face)
Comparison usual care
Published
after 2009
12 months
58% reduction in
Cardiovascular
Mortality
30% reduction in MI
Slide3Efficacy of cardiac rehabilitation
ReviewPopulationIntervention OutcomeAnderson et al., 2016Cochrane LibraryCoronary heart diseaseExercise-training alone or in combinationComparison usual care12 months26% reduction in Cardiovascular Mortality 18% reduction in Hospital AdmissionsCost-effectiveVan Halewjin et al., 2017 Int J CardioCoronary heart disease ≥ 50%Cardiac rehabilitation and secondary prevention (face-to-face)Comparison usual carePublished after 2009 12 months 58% reduction in Cardiovascular Mortality 30% reduction in MIPowell et al., 2018BMJ OpenCoronary heart diseaseExercise-training alone or in combinationComparison usual carePublished 2000-201712 monthsNo difference in Cardiovascular Mortality or MI5% reduction in Hospital Admissions
Abell, Zecchin, Gallagher HLC 2018
Slide4Slide5Slide6The Global Survey of Cardiac Rehabilitation
Observational cross-sectional study of Phase II cardiac rehabilitation programs internationallyGlobal team led by Sherry Grace, York University Canada, ICCPR93/112 (83%) countries internationallyACRA Australian champions: distributed anonymous survey link to members 2016-2017
Supervia, Turk-Adawi, Grace 2017
Slide7Research aim
To describe availability of resources and any resource barriers to CR service delivery in Australia
Slide8Methods
Sample
Phase II CR programs eligible: initial assessmentstructured exercise≥ one other strategy to control cardiovascular risk factors
Survey topics
Program content (assessment, delivery
and
topics)
Staff supervision of content
ATSI support & participation
Annual
volume and capacity
Barriers to
serving patients
Staffing
Overall resources
Slide9Participating programs
n%Region Urban (large cities/towns)Suburban (city outskirts)Rural32193038.122.635.7Location Community hospitalMajor hospitalRehabilitation facilityNot hospital-based3024101935.728.611.922.6On-site cardiac services Cardiology servicePCICABGTransplant333014139.335.716.71.2Administration Community healthCardiologyRehab/internal medicineAllied health General practice3022238235.726.227.39.52.4
Response rate 85/314 (27
%)
Slide10Resource barriers to improving patient participation
Slide11Costs of program delivery
Slide1289.3
% multidisciplinary teams 65.5% ≥ 5 different disciplines
Personnel
Slide13Program space
Slide14Patients served
Current patients/year
58/85 (68%) could provide the number Median 215 (range 6-1516)
Potential patients
60/85 (71%)
could provide the
number
Median 200 (range 24-1000)
Slide15Knowing program numbers
Slide16Limitations
Response rate 27%
Appropriateness of responder – 78% coordinator
Validity – questions pitched to an international audience
Slide17Resource barriers to service delivery internationally
Turk-Adawi, BMC 2015
Finance, staffing and space are barriers across the globe
Slide18Patient capacity comparison internationally
Programs being at capacity is an issue across the globe
Slide19Patient costs internationally
Poor national understanding of per person costs in Australia
Slide20Conclusions for Australian CR programs
Key barriers to service delivery included staffing, equipment and space
Program resources may not relate to service delivery needs
Not all CR program coordinators could report the key information needed to support business cases for current and ongoing services
Potential solution for efficient resource evaluation lies in collaboration across service boundaries e.g. participation in a national minimum data set
Slide21The challenge for CR in Australia
A national quality assessment process is urgently needed to support programs to understand both individual and national level cardiac rehabilitation delivery, provide benchmarks for improvement and provide an insight into costs.
The Australian Cardiovascular Health and Rehabilitation Association (ACRA) must have a key role in this process.
Slide22The Global Cardiac Rehabilitation Survey: Program resources and impact in Australia
Robyn GallagherMarta SuperviaKaram Turk-AdawiDion CandelariaLaila LadakLis NeubeckSherry Grace