Assessing health professionals’ 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 care providers in this area, following myocardial infarction, to understand what issues health professionals saw in their practice.

 

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

Strategy: Interview care providers delivering the pathway for acute coronary syndrome in secondary care and cardiac rehabilitation.

 

Methods: Semi-structured interview; Thematic Framework Analysis; 20 health care providers.

 

Results: We sought to engage with all providers in the care pathway. We recruited a service manager and consultant cardiologist for a broad overview; senior / junior nurses and health care assistants for views on in-patient care; and nurses, physiotherapists, exercise therapists, dietitians, clinical psychologist and occupational therapist to outline the rehabilitation programme.

 

Care providers described their work, expressing overall good patient engagement and satisfaction with the provision. They recognised the service was situated in an area of socioeconomic deprivation. Immediate counselling after myocardial infarction is provided by the cardiac rehabilitation practitioners, and supported by several members of the ward team, who explain and reiterate messages in a multidisciplinary manner. The provision of rehabilitation services at several sites to facilitate attendance was seen as positive. Providers were happy to conduct these sessions in multiple locations. This placed care givers in a variety of socioeconomic locations, reflective of the catchment area. Providers described disparities in health literacy across this region, and some patients having low baseline levels of medical and health seeking knowledge. Language barriers impact some participants in taking full benefit of rehabilitation sessions. Familial and work obligations for some patients prevented their full engagement. The dietary advice offered would mean a massive wholesale change in the types, quantities and nature of foods eaten.

 

The change recommended could incur financial cost, and conflict with cultural practice and habits. Unpicking this in the sessions is a challenge.

Some views related to the resource available. There was a perception of the service being staffed at a lower level than optimal. In order to provide cover with the staffing available some care providers were employed on a part-time basis. The demand for out-patient care is ever-increasing, and this impacts patients seen in cardiac rehabilitatiton that require follow-up, or a prompt review following clinical deterioration.

 

Implications: The data describes experiences of health professionals in delivery of care following a myocardial infarction in an area of relative socioeconomic deprivation. It gives specific insight into local barriers that providers feel patients face when accessing the care on offer, and how users struggled with implementing the lifestyle changes that are required to optimise outcomes. Participants referenced the limited resource available to serve the growing out-patient demand. The participants suggested ways in which the service could be expanded, to inform future developments.