Assessing patient experience of care following myocardial infarction in an area of unequal cardiovascular outcomes.

Background: The rate of premature preventable cardiovascular disease in Luton is high, in spite of well-developed preventative and interventional services in the community, primary and secondary care. The town is a region of relative deprivation, with a multicultural patient base and many potential barriers to care. We sought to assess experience of patients in this area, following myocardial infarction, to define barriers these patients face in optimal health behaviour following a major cardiovascular event.

 

Approach: Research questions: Are existing measures providing effective care to patients? What are the barriers that impair effectiveness of the current provisions?

 

Strategy: Interview of patients who have sustained a myocardial infarction presenting to Luton Hospital, who are taking part in the cardiac rehabilitation programme.

Methods: Semi-structured interview; Thematic Framework Analysis; 25 patients.

 

Results:Patient experience: The recruitment strategy encompassed a sample of our patient population, including patients from a broad range of ethnicities. We aimed to have an equal number of male and female participants, but the sample was skewed towards male subjects, dependent on patients’ willingness to participate.

Patients expressed a positive cardiac rehabilitation experience overall, and defined barriers to participation. Those from a higher socioeconomic strata were very enthusiastic regarding the positive experience. Those with less means defined financial barriers to engaging with the cardiac rehabilitation programme. The classes are heavily subsidised, and there is a nominal fee for later stages of the programme, that seems negligible at £4. However this proved too much for some patient groups.

Health literacy was variable, and the ability to enact lifestyle change was variable – patients understood the need to make healthier decisions, but felt unable to in view of other obligations.

Other findings reflect the mismatch between demand and resource. There was a consensus that the delay between in-patient care and subsequent medical review by a doctor was too long. They suggested that more frequent reviews following rehabilitation, with a faster start to the programme, would be of benefit. Participants would prefer more prompt and frequent follow-up from consultants. Some participants would be keen to take up remote or out-of-hours sessions, to facilitate participation.

Finally a proportion of the population indicated that their participation would be facilitated by situating classes in their local area with facilitators that spoke the same language. They suggested greater outreach, and culturally sensitive education, could be provided in areas with increased deprivation.

Implications: The data gives specific insight into the barriers faced by patients in accessing the care on offer, and implementing the lifestyle changes that are required to optimise outcomes. Some needs relate to the limited resource available to serve a growing out-patient population. Other needs lay bare the economic barriers faced by some patients. Participants speak of a need to tailor the provision to the needs of specific patient populations. This suggests a role for greater engagement in the community outside of what is offered in primary and secondary care, perhaps indicating a need for community champions to work in this area.