Setting up and auditing guideline- and evidence-based cardiac rehabilitation.
BACKGROUND
Rehabilitation is available to only a minority of post-myocardial infarction (MI) patients and is of variable quality. Guidelines now recommend individualised care delivered by hospital, primary care and community services, but there is little evidence of the feasibility, acceptability or effectiveness of this approach.


OBJECTIVE
To demonstrate the feasibility of guideline-based rehabilitation, to audit delivery and outcome and to identify problems.


METHODS
A four-phase stepped programme for post-MI patients was developed based on individualised in-hospital care and aftercare from a menu of options. Delivery involved co-ordination between hospital services, primary care and community services. Self-report audit data were collected in hospital and at 3 months post-discharge by postal questionnaire and telephone calls. Clinical information was recorded from hospital, telephone and outpatient contacts. Delivery of care to patients receiving interventions was recorded.


RESULTS
It was possible to negotiate individualized plans for all patients and to monitor progress for 3 months after discharge. The rehabilitation team achieved high rates of delivery of agreed interventions, considerably better than delivery by primary care. Problems largely related to difficulties and failures in communication. Patients with major social or psychological difficulties were the most difficult to treat.


CONCLUSIONS
Guideline-based rehabilitation is feasible, but there is a need to improve the coordination of delivery of later steps of care and also to refine specialist interventions.
Mayou
Richard
R
Oxford University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. richard.mayou@psych.ox.ac.uk
Welstand
Jenny
J
Tyndel
Sally
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration; D004739:England; D019317:Evidence-Based Medicine / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000451:nursing / Q000534:rehabilitation*; D020380:Needs Assessment / Q000458:organization & administration; D009730:Nursing Assessment / Q000458:organization & administration; D009731:Nursing Audit / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010347:Patient Care Planning / Q000458:organization & administration; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D019145:Rehabilitation Nursing / Q000592:standards*; D011795:Surveys and Questionnaires