For both cardiac rehabilitation and HF models of care, services can be delivered in a variety of settings, including hospital (e.g., ward –based, outpatient clinics), home, community, and using telephone-based approaches. [ #woodruffe-s-neubeck-l-clark-ra-et-al.-2015, #clark-ra-inglis-sc-mcalister-fa-et-al.-2007, #mcalister-fa-stewart-s-ferrua-s-et-al.-2004, #phillips-co-singa-rm-rubin-hr-et-al.-2005]
During the inpatient phase, rehabilitation services should focus on the following aspects.
Rehabilitation services should provide:
- Practical support regarding clinical management and the hospital stay
- Delivery information and advice around risk modification, self management principles, resumption of activity, driving and return to work, where relevant to the individual
- Early discharge support
- Introduction and referral to post acute management and follow up
Post hospital discharge patients may be followed up in a range of settings.
Options for patients following hospital discharge
- Centre based approaches may include a variety of interactions from one on one clinic visits to comprehensive disease management programs.
- Individual consultations are useful for initial review post-discharge, initial assessment for exercise rehabilitation and for patients with complex needs, such as those requiring medication titration or psychological support
- Multidisciplinary rehabilitation programs conducted in hospitals or community settings should, where possible, include both exercise as well as education sessions. These are generally conducted as a group to provide patients with social interaction
- For rehabilitation, the hospital setting is preferable for patients with: severe or unstable disease (including those awaiting heart transplant), complex co-morbidities and supplemental oxygen requirements
- Patient follow up provided in a centre is usually more economical and time efficient than home visits and offers easy access to a range of clinicians
- Home-based support may be delivered by a variety of approaches including face-to-face home visits, telephone or video coaching, and computer or mobile phone programs
- Home-based support can provide access to services for patients who are working, who experience transport difficulties or have severe deconditioning following an inpatient admission
- Interviewing patients at home helps identify issues such as expired, duplicated or medicines that have previously been stopped, as well as the storage conditions of medicines (e.g., GTN tablets). Over-the-counter complementary medications may also be more readily available for review in the home setting