title: Evaluation of a rural primary-referred cardiac exercise tolerance test service.
abstract: OBJECTIVE
  To describe the feasibility, clinical impact and cost-effectiveness of a rural generalist-led cardiac exercise tolerance test (ETT) service for primary care patients in two different rural communities.
  
  
  METHODS
  For 12 months, from Sept 2011, a generalist-led ETT service was provided in two rural hospitals in New Zealand: Dunstan in Central Otago and Rawene in Northland. Data was collected to describe the patient outcomes of this service. An audit of ETT reports and financial and rural-urban analyses were undertaken.
  
  
  RESULTS
  The cost per test of the local ETT service at Dunstan, ($132.50), and Rawene, ($200.00), was less than the national price ($281.13 in 2012). The majority of patients (83% at Dunstan and 70% at Rawene) were not referred to specialist services; the ETT result allowing the GP to continue to manage the patient in primary care. Where the ETT indicated specialist treatment, this was subsequently provided in a timely manner.
  
  
  CONCLUSIONS
  ETT can be provided cost-effectively in a variety of rural settings. Improved access to ETT for rural communities may help address inequities across New Zealand in terms of access to cardiac investigations and early and appropriate treatment.
authors.affiliation: Hokianga Health Enterprises Trust, Private Bag, Kaikohe 0400, New Zealand. kati.blattner@hokiangahealth.org.nz.
authors.forename: Katharina
authors.initials: K
authors.lastname: Blattner
authors.forename: Garry
authors.initials: G
authors.lastname: Nixon
authors.forename: Carol
authors.initials: C
authors.lastname: Horgan
authors.forename: Jayne
authors.initials: J
authors.lastname: Coutts
authors.forename: Marara
authors.initials: M
authors.lastname: Rogers
authors.forename: Brandon
authors.initials: B
authors.lastname: Wong
authors.forename: John
authors.initials: J
authors.lastname: Wigglesworth
authors.forename: Gerard
authors.initials: G
authors.lastname: Wilkins
mesh_terms: D003362:Cost-Benefit Analysis; D005080:Exercise Test / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D017079:Exercise Tolerance; D005240:Feasibility Studies; D058006:General Practice; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D009520:New Zealand; D012017:Referral and Consultation; D019035:Rural Health Services / Q000191:economics; D012424:Rural Population; D059039:Standard of Care; D014505:Urban Population