TY - JOUR
T1 - Preparing for change in the secondary prevention of coronary heart disease
T2 - A qualitative evaluation of cardiac rehabilitation within a region of Scotland
AU - Clark, Alexander M.
AU - Barbour, Rosaline S.
AU - McIntyre, Paul D.
PY - 2002/9
Y1 - 2002/9
N2 - Background. Secondary prevention of Coronary Heart Disease (CHD) is often poorly managed and its benefits attained in only a minority of those with CHD. Guidelines developed in the United Kingdom and North America suggest that in future cardiac rehabilitation programmes should provide services through individualized programmes that cater for a wide range of conditions associated with CHD. This will involve substantial and costly changes to current programmes that are mostly standardized and for postmyocardial infarction patients. Based on change theory, this study examined the dynamics, strengths and weaknesses of an existing programme in a Scottish region which was due to undergo the changes suggested by guidelines. Aim. To examine the perceived provision of secondary prevention services for CHD from the perspectives of health professionals within one region in the West of Scotland. Methods. A purposive sample of 14 health professionals (eight primary and six secondary care health professionals) was selected to cover a range of professional roles including both specialists and generalists. Separate focus group discussions (2) were held with primary care and secondary care professionals. Findings. Whilst the health professionals were enthusiastic about CHD prevention and their involvement, they perceived barriers to the success of the existing service as being complex and multifactorial, including patient, social and service-related factors. Although both groups identified motivation as the most influential personal factor, secondary care staff tended to focus on the importance of patient factors in influencing motivation to change, whereas the primary care staff referred more to the cumulative effects of social and cultural factors. Professionals highlighted weaknesses in the transition between hospital and community-based services with regard to the information flow between primary and secondary care. Conclusions. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation programme development and intersectoral working, such as communications and role perceptions in multi-professional working and the need to adapt services to local socioeconomic conditions.
AB - Background. Secondary prevention of Coronary Heart Disease (CHD) is often poorly managed and its benefits attained in only a minority of those with CHD. Guidelines developed in the United Kingdom and North America suggest that in future cardiac rehabilitation programmes should provide services through individualized programmes that cater for a wide range of conditions associated with CHD. This will involve substantial and costly changes to current programmes that are mostly standardized and for postmyocardial infarction patients. Based on change theory, this study examined the dynamics, strengths and weaknesses of an existing programme in a Scottish region which was due to undergo the changes suggested by guidelines. Aim. To examine the perceived provision of secondary prevention services for CHD from the perspectives of health professionals within one region in the West of Scotland. Methods. A purposive sample of 14 health professionals (eight primary and six secondary care health professionals) was selected to cover a range of professional roles including both specialists and generalists. Separate focus group discussions (2) were held with primary care and secondary care professionals. Findings. Whilst the health professionals were enthusiastic about CHD prevention and their involvement, they perceived barriers to the success of the existing service as being complex and multifactorial, including patient, social and service-related factors. Although both groups identified motivation as the most influential personal factor, secondary care staff tended to focus on the importance of patient factors in influencing motivation to change, whereas the primary care staff referred more to the cumulative effects of social and cultural factors. Professionals highlighted weaknesses in the transition between hospital and community-based services with regard to the information flow between primary and secondary care. Conclusions. Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation programme development and intersectoral working, such as communications and role perceptions in multi-professional working and the need to adapt services to local socioeconomic conditions.
KW - Cardiac Health Promotion
KW - Change
KW - Development
KW - Interface
KW - Organizations
KW - Primary care
KW - Quality
KW - Services
UR - http://www.scopus.com/inward/record.url?scp=0036730551&partnerID=8YFLogxK
U2 - 10.1046/j.1365-2648.2002.02328.x
DO - 10.1046/j.1365-2648.2002.02328.x
M3 - Journal Article
C2 - 12207757
AN - SCOPUS:0036730551
SN - 0309-2402
VL - 39
SP - 589
EP - 598
JO - Journal of Advanced Nursing
JF - Journal of Advanced Nursing
IS - 6
ER -