4.6 Article

Implementation and prospective evaluation of the Country Heart Attack Prevention model of care to improve attendance and completion of cardiac rehabilitation for patients with cardiovascular diseases living in rural Australia: a study protocol

Journal

BMJ OPEN
Volume 12, Issue 2, Pages -

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2021-054558

Keywords

preventive medicine; cardiology; telemedicine

Funding

  1. National Health and Medical Research Council [GNT1169893]
  2. Flinders University
  3. Integrated Cardiac Clinical Network (iCCnet SA)
  4. National Heart Foundation of Australia
  5. Exercise and Sports Science Australia (ESSA)
  6. Australian Cardiac Rehabilitation Association (ACRA)
  7. Country Health SA
  8. Cardiac Society of Australia and New Zealand (CSANZ)
  9. Flinders Foundation
  10. Royal Australian College of General Practitioners (RACGP)
  11. AstraZeneca
  12. Novartis
  13. Health Translation SA
  14. Enterprise Data and Information Department of Health and Wellbeing, SA Health
  15. Australian Government Department of Health
  16. Medical Research Future Fund Investigator Grant [1193862]

Ask authors/readers for more resources

This study aims to develop and implement a cardiac rehabilitation (CR) care model in rural Australia using a large-scale knowledge translation model to improve CR attendance and completion. The study will collaborate with patients, clinicians, and health service managers to develop new approaches and address known barriers to CR attendance. Additionally, the study will promote clinician endorsement of CR and develop an electronic referral system to increase referral rates. Professional development interventions and an accreditation program will be developed to promote CR quality improvement.
Introduction Despite extensive evidence of its benefits and recommendation by guidelines, cardiac rehabilitation (CR) remains highly underused with only 20%-50% of eligible patients participating. We aim to implement and evaluate the Country Heart Attack Prevention (CHAP) model of care to improve CR attendance and completion for rural and remote participants. Methods and analysis CHAP will apply the model for large-scale knowledge translation to develop and implement a model of care to CR in rural Australia. Partnering with patients, clinicians and health service managers, we will codevelop new approaches and refine/expand existing ones to address known barriers to CR attendance. CHAP will codesign a web-based CR programme with patients expanding their choices to CR attendance. To increase referral rates, CHAP will promote endorsement of CR among clinicians and develop an electronic system that automatises referrals of in-hospital eligible patients to CR. A business model that includes reimbursement of CR delivered in primary care by Medicare will enable sustainable access to CR. To promote CR quality improvement, professional development interventions and an accreditation programme of CR services and programmes will be developed. To evaluate 12-month CR attendance/completion (primary outcome), clinical and cost-effectiveness (secondary outcomes) between patients exposed (n=1223) and not exposed (n=3669) to CHAP, we will apply a multidesign approach that encompasses a prospective cohort study, a pre-post study and a comprehensive economic evaluation. Ethics and dissemination This study was approved by the Southern Adelaide Clinical Human Research Ethics Committee (HREC/20/SAC/78) and by the Department for Health and Wellbeing Human Research Ethics Committee (2021/HRE00270), which approved a waiver of informed consent. Findings and dissemination to patients and clinicians will be through a public website, online educational sessions and scientific publications. Deidentified data will be available from the corresponding author on reasonable request.

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