A National Health Service Hospital's cardiac rehabilitation programme: a qualitative analysis of provision.
OBJECTIVE
This paper reports a study examining the effectiveness of a London National Health Service Trust Hospital's cardiac rehabilitation programme, from the perspectives of healthcare professionals and patients.


BACKGROUND
Cardiovascular disease is the world's leading cause of death and disability. Substantial research has reported that, following a cardiac event, cardiac rehabilitation can promote recovery, improve exercise capacity and patient health, reduce various coronary artery disease risk factors and subsequently reduce hospitalization costs. Despite these findings and the introduction of the National Service Framework for Coronary Heart Disease, there is wide variation in the practice, management and organization of cardiac rehabilitation services.


METHODS
A purposeful sample of three postmyocardial infarction patients registered on the selected hospital's cardiac rehabilitation programme, coupled with 11 healthcare professionals were selected. The patients acted as individual case studies. The authors followed all three patients through phase III of their cardiac rehabilitation programme. The research attempted to explore the roles and procedures of a London hospital's cardiac rehabilitation programme through an interpretative framework involving qualitative research methods. Participant observation and in-depth semi-structured interviews were the instruments used to collect data.


RESULTS
Whilst the healthcare professionals were enthusiastic about coronary heart disease prevention, the London NHS trust hospital's cardiac rehabilitation programme had several barriers, which reduced the programme's success and prevented it from achieving National Service Framework targets. The barriers were complex and mainly included service-related factors, such as lack of professional training, weak communication between primary and secondary care and confused roles and identities.


CONCLUSIONS
Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation and secondary prevention programme development, such as communication and role and identity perceptions in a multi-professional working environment and the need to develop a formal training programme for cardiac rehabilitation healthcare professionals.


CONCLUSIONS
The results of this study highlight the need for increased investment, improved planning and the introduction of a comprehensive training programme for healthcare practitioners in cardiac rehabilitation. Implementation of these actions may reduce many of the service limitations and barriers that currently surround cardiac rehabilitation programmes.
O'Driscoll
Jamie M
JM
School of Sport and Education, Brunel University, Middlesex, and Health and Exercise Sciences Group, Thames Valley University, Berkshire, UK. jamie.o'driscoll@tvu.ac.uk
Shave
Robert
R
Cushion
Christopher J
CJ
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003144:Communication Barriers; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training; D008131:London; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000534:rehabilitation; D020380:Needs Assessment; D015404:Nursing Methodology Research; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D024382:Professional Role / Q000523:psychology; D015397:Program Evaluation; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires