The Shortage of Cardiac Rehab Programs in Rural Oklahoma.
However, despite the evidence supporting the effectiveness of cardiac rehabilitation, only one in three post-ACS patients adhere to the recommendations to participate in cardiac rehabilitation (Doll, 2015). Several challenges exist that account for this statistic: there are very few cardiac rehab facilities that are within a convenient traveling distance. According to the Oklahoma Association of Cardiovascular and Pulmonary Rehabilitation (2017), the state has approximately 30 rehabilitation service facilities. Most are concentrated in the Tulsa and Oklahoma City metropolitan area. The lowest concentration of cardiac rehabilitation programs is in Western Oklahoma. Without a rehab facility in close proximity to home, patients struggle to find time to travel to and from the services that they are eligible for and would benefit from. Additional barriers to participation include the hours of operation of some programs and the cost that patients may incur to utilize services. These barriers make it difficult or impossible for some patients to participate in the services provided by cardiac rehab facilities.
It is critical that cardiac nurses in Oklahoma understand the challenges rural patients have in adhering to post-ACS recommendations so that we can help break down barriers, optimize compliance, and improve health outcomes. Nurses should screen patients for challenges they'll have in participating in post-ACS recommendations. At discharge, the nurse should include thorough education regarding prescription medications and discuss the importance of follow up care (Cardiac Care Network, 2013). When cardiac rehab is not accessible, the American Heart Association (2017) recommends referring the patient to a cardiologist for individualized exercise plans and offers an online support network for patients. Emphasis should be placed on measures that will ensure a smooth transition from the acute setting to the home setting such as ensuring that the patient does not have a delay in obtaining prescriptions and that the post-discharge plan is clear (Cardiac Care Network, 2013). The Cardiac Care Network also emphasizes that the use of technology, such as telemonitoring, helps to bridge access to cardiac rehabilitation for people in remote areas (2013).
Additionally, nurses can maximize adherence to post-ACS recommendations by helping patients to identify concerns and barriers. It may help to provide resources from the American Heart Association website regarding physical activity and wellness. Nurses can investigate the AHA website to learn more about cardiac rehab, frequent patient concerns, and available resources for patients.
American Heart Association. (2017). What is cardiac rehab? Retrieved August 11, 2017 from http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/Whatis-Cardiac-Rehabilitation UCM 307049 Article.isp#.WY3LEumQvUk
Cardiac Care Network. (2013). Management of acute coronary syndromes: Best practice recommendations for remote communities. Retrieved March 26th, 2017 from http://www.ccn.on.ca/ccn public/uploadfiles/files/ACS management in remote communities FINAL Sept 2013.pdf
Doll, J., Hellkamp, A., Ho., P., Kontos, M. (2015). Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction. JAMA Intern Med. 175 (10):1700-1702. doi:10.1001/jamainternmed.2015.3819
Oklahoma Association for Cardiovascular and Pulmonary Rehabilitation. (2017). Rehab programs. Retrieved from http://okcvpr.com/rehab-programs/
Toni Metheny, MS, RN, CNE and Juliana Bell, MS, RN
Metheny is affiliated with The University of Oklahoma Science of Nursing. Bell is affiliated with Southwestern Oklahoma State University School of Nursing. ONA membership status: Bell is a current member.
Caption: Figure 1: Locations of cardiac rehabilitation programs in Oklahoma. Adapted from "Rehab Programs" by Oklahoma Association for Cardiovascular and Pulmonary Rehabilitation, 2013, (http://okcvpr.com/rehab-programs/). In the public domain. Large stars depict a higher concentration of programs.
|Printer friendly Cite/link Email Feedback|
|Author:||Metheny, Toni; Bell, Juliana|
|Date:||Mar 1, 2018|
|Previous Article:||Let them hear your voice!|
|Next Article:||Tips for Effective Legislative Communication.|