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Patients

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... Donner, A. P. et al (1983) Predictors of Dropout from Cardiac Exercise Rehabilitation. ... Benefits of cardiac ... .What do you think the cardiac rehab course ... – PowerPoint PPT presentation

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Title: Patients


1
Patients perspective of the factors for
non-attendance to and non-completion of a phase
III cardiac rehabilitation programme A
qualitative study.
  • Mary Kerins

2
Background
  • Part of a mixed method study
  • Single site
  • 2006-2007
  • 267 patients enrolled for a cardiac
    rehabilitation programme, 50 patients did not
    attend and 30 patients did not complete the
    programme. 
  • Quantitative study showed that smokers and
    non-skilled manual workers were more likely not
    to attend
  • Telephone Survey
  • Not interested
  • Illness

3
Background (continued)
  • Benefits of cardiac rehabilitation are well
    documented (Jacob 1999Clarke et al 2004)
  • Non-attendance /non-completion - many recent
    studies have examined this phenomenon (Yohannes
    et al 2007 Cooper et al 2007 Sanderson and
    Bittner 2005 Hemmingway 2003)
  • Completion rates range from 58-89 (Sanderson
    et al 2003 Jennings et al 2006)
  • Non-attendance rates range 4-14 (Turner et al
    2002 Roblin et al 2004Blackburn et al 2000)
  • Drop out rates range 30-50 (Carlson et al 2001
    Turner et al 2002 Farley et al 2003 Chan et al
    2005)

4
Purpose
  • To examine the factors why patients do not attend
    or do not complete cardiac rehabilitation
    programmes after freely enrolling.
  • To enhance quantitative arm of study

5
Method
  • 50 patients did not attend and 30 patients did
    not complete the programme. Ten were identified
    and invited for interview, of those, seven agreed
    to be interviewed
  • Convenience sample
  • Semi structured interviews were done

6
Method (continued)
  • The interviews were an in depth analysis of the
    factors that contributed to their non-attendance
    or non-completion of the programme. An interview
    schedule was developed using apriori themes.
    These themes were derived from the researcher's
    clinical experience and the literature. The
    interviews were transcribed and coded to the
    various themes in NVivo.
  • Template analysis

7
Method
  • Ethics
  • - Approval from AMNCH/SJH joint Ethics committee

8
Results
9
 
 
10
Results
11
Exercise Quotes Anthony The exercise part of
it was boring for my age group. Like I was only
45 and I was exercising with people of 65. I had
no problem with that but with myself I had, I
wanted to give that little bit more, where, when
I felt that, like I mean there was only a certain
limit that the people of sixty were able to do
and it sort of slowed me down in that aspect
(Document Anthony, Section 0, Paragraphs
33-34, 403 characters)
12
Exercise Quotes and, my, needs were totally
different, and , I did try to keep up , but I
just felt, it was doing me, it wasnt doing me
good. I was feeling it more, difficult because I
just wasnt able for it (Document Breda,
Section 0, Paragraph 19, 195 characters)
13
Exercise Quotes Peter Some, of the things,
like, were grand, like, and I could have done a
little bit longer, but others, it was a, it was a
strain to get to the final, you
know.. Researcher You know, youre saying
now that you did not finish because the exercise
was too difficult for you. Is that what Im
taking from you? Peter Yes (Section 0,
Paragraph 241, 137 characters.)
14
Access and I had more of a workout sitting in
traffic for an hour and a half trying to get here
which was the problem, like you know what I mean,
like I came from the north side of the city all
the way to the south (Document Anthony,
Section 0, Paragraph 51, 205 characters)
15
Access but spending nearly four hours on the
road getting in and out is not good time
management (Document Breda, Section 0,
Paragraph 64, 86 characters) Then its hard
to get parking,.. (Document Peter, Section 0,
Paragraphs 161-162, 64 characters.)
16
Health and Risk factors Breda Physically I
was weaker. My autoimmune problem was much more
active. I was sweating profusely, I was feeling
awful, and I felt, you know other than that, I
just felt awful. I felt more and more anxious
(Document Breda, Section 0, Paragraphs 149-150,
335 characters) Researcher How much exercise
do you normally do? Mel None (Document Mel
Section 0, Paragraphs 139-142, 214 characters)
17
 
 
18
Results
19
Self Anthony Well, I wasnt, I have to say, I
didnt drop out of the cardiac because of the
cardiac. I did not finish mentally (Document
Anthony Section 0, Paragraphs 126-136, 1310
characters) Sean I didnt need, I didnt want
to, I knew I wasnt well enough to do any
programme at the time as well. My mind wasnt
telling me yes, go and do it (Document Sean.
Section 0, Paragraph 37, 148 characters)
20
Depression Anthony After the cardiac problem,
I ended up been very, very depressed. And, ah, it
brought a big strain on the household, because
the mood swings were up and down. The first
couple of weeks I had a terrible fear of getting
meself isolated on my own anywhere (Document
Anthony, Section 0, Paragraph 14, 250
characters)
21
Stress Sean .but all that stress didnt help
me, didnt help the wife or the family. And I
went through a lot of that (Document Sean,
Section 0, Paragraph 164, 105 characters)
Family Mel.I wouldnt
leave her any longer than an hour, two hours
No, in case she would fall, you know, she
wouldnt be able to get up (Document Mel
Section 0, Paragraphs 113-116, 304 characters)
22
Results
23
Perceptions of the programme Researcher .What
do you think the cardiac rehab course was all
about? Mel I really thought it was, just, you
go down, and you do exercises. You know. Em, so
much exercises, you know. Thats what I thought
it was, just exercises (Document Mel, Section
0, Paragraphs 200-207, 478 characters.)

24
Work Sean I hadnt, as I say I had a lot going
on as well, at home, I had a lot going on after
the operation, feeling down, depressed, the job,
I had, at the time I was doing morning work, I
knew I couldnt do the eight weeks because I had
to be at work at ten o clock at the time
(Document Sean, Section 0, Paragraphs 191-192,
574 characters.)
25
The System Breda I was over in the clinic
again, recently and doctor P wasnt there, there
was a student with a supervising doctor, you
actually feel like they could put a cardboard cut
out on the chair and they wouldnt know the
difference. Youre not... .. And a lot of
patients that you meet in the queues and the
cardiac group will say that if you dont fit into
the neat box, then nobody is comfortable with
you. And that would be very much, what I would,
think.. , the patient isnt the focus when you
come to hospital (Document Breda Section 0,
Paragraphs 26-32, 1345 characters.)
26
Noel I went to ah, sixth class.. but I didnt
do well in it now but Researcher Did you
not? Noel Oh no, no (Document Noel,
Section 0, Paragraphs 65-70, 236 characters.)
27
 
 
28
Conclusion
  • The patients interviewed had mainly issues with
    the exercise regime on the programme,
    depression/stress, work and the programme itself.
    A low level of education was also evident.
  • Although Phase III programmes are now mainly menu
    based, with exercise individually prescribed,
    this study has shown that there are still many
    outstanding factors that strongly influence
    patients non attendance/non completion of
    programmes which could be addressed.

29
Recommendations
  • Further attention is required to individual needs
    within Phase III programmes, thus motivating
    patients and encouraging their choice even more
  • Initiating changes that will improve patient
    choice, perhaps shorter more intensive
    programmes, or increasing availability of
    programmes to outside normal working hours,
    different modes of delivery of exercise progamme

30
Recommendations
  • A more comprehensive recruitment session for
    programmes comprising in depth assessment of
    patients profile, individual needs, readiness
    for change, beliefs, anxiety and depression.
  • A more comprehensive programme introduction.
  • Coordinator intervention calls

31
Thank you
Mary Kerins
32
References
  • Carlson, J.J. Johnson, J.J. et al (2000)
    Programme Participation, Exercise Adherence,
    Cardiovascular Outcomes, and Program Costs of
    Traditional Versus Modified Cardiac
    Rehabilitation. The American Journal of
    Cardiology 86(1) 17-23.
  • Clarke, A. Barbour R, et al (2004) Issues and
    Innovations in Nursing Practice Promoting
    Participation in Cardiac Rehabilitation Patient
    Choices and Experiences. Journal of Advanced
    Nursing 47(1) 5-16.
  • Cooper, A. F. Weinman, J. (2007) Assessing
    Patients Beliefs about Cardiac Rehabilitation as
    a Basis for Predicting Attendance after Acute
    Myocardial Infarction Heart 9353-58.
  • Farley, R. L. Wade, T. D. et al. (2003) Factors
    Influencing Attendance at Cardiac Rehabilitation
    among Coronary Heart Disease Patients European
    Journal of Cardiovascular Nursing 2(3) 205-212.
  • Hemingway, A. (2003) Factors which may Affect
    Attendance at Cardiac Rehabilitation.
    Bournemouth, Institute of Health and Community
    Studies Bournemouth University 1-38.
  • Jacob, M. (1999) Building Healthier Hearts
    Report of the Cardiovascular Health Strategy
    Group. G. S. Office. Dublin, Department of Health
    and Children.
  • Jennings, S. and D. Carey (2002) Capacity and
    Equity in Cardiac Rehabilitation in the Eastern
    Region Good and Bad News. Irish Journal of
    Medical Science 173(3)
  • 151-154.
  • Jolly, K. Greenfield, S. M. et al. (2004)
    "Attendance of Ethnic Minority Patients in
    Cardiac Rehabilitation." Journal of
    Cardiopulmonary Rehabilitation 24(5) 308-312.
  • Jones, N.L. Schneider, P.L. et al (2007) An
    Assessment of the Total Amount of Physical
    Activity of Patients Participating in a Phase III
    Cardiac Rehabilitation Programme. Journal of
    Cardiopulmonary rehabilitation and Prevention.
    27(2) 81-85.

33
References
  • Oldridge, N. B., Donner, A. P. et al (1983)
    Predictors of Dropout from Cardiac Exercise
    Rehabilitation. The American Journal of
    Cardiology 51 70-74.
  • Sanderson, B. K. and V. Bittern (2005) Women in
    Cardiac Rehabilitation Outcomes and Identifying
    Risk of Dropout. American Heart Journal 150(5)
    1050-1058.
  • Sanderson, B. K. Phillips, M. M. et al (2003)
    Factors Associated with the Failure of Patients
    to Complete Cardiac Rehabilitation for Medical
    and Nonmedical Reasons
  • Turner, S. C. Bethell, H. J. N. et al (2002)
    Patient Characteristics and Outcomes of Cardiac
    Rehabilitation Journal of Cardiopulmonary
    Rehabilitation 22 253-260.
  • Yohannes, A. M. Yalfani, A. et al (2007)
    Predictors of Drop-out from an Outpatients
    Cardiac Rehabilitation Programme. Clinical
    Rehabilitation 21(3) 22-229.
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