Patient choice for home-based cardiac rehabilitation was often driven by constraints such as lack of information, transport issues, and inflexible working hours rather than a positive preference.
Observational (n=47)
Yes
What factors influence patients' choices between home-based and hospital-based cardiac rehabilitation?
Patient choice between home- and hospital-based cardiac rehabilitation is often limited by systemic and socio-economic barriers, highlighting the need for improved service accessibility to enable true individualized care.
AIM: This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation. BACKGROUND: In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice. METHODS: Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008. FINDINGS: While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport). CONCLUSION: The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs.
Madden et al. (2011) conducted an observational in Cardiac rehabilitation (n=47). Home-based cardiac rehabilitation vs. Hospital-based or community-based cardiac rehabilitation was evaluated on Patients' experiences of being offered a choice of rehabilitation programme. Patient choice for home-based cardiac rehabilitation was often driven by constraints such as lack of information, transport issues, and inflexible working hours rather than a positive preference.