Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

BACKGROUND

Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations.

METHODS

The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment.

RESULTS

The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ± 0.69 (mean ± standard deviation), 5.33 ± 1.12 and 5.64 ± 1.08, respectively.

CONCLUSIONS

Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.

Nepal Medical Council: The past and the future

The Nepal Medical Council (NMC) has been technically in operation for forty six years though in reality it is much less. The initial years were spent in establishing it. It is only in the last fifteen years or so that there has been much interest in it's functioning. The objective of the NMC is to protect the public and also to oversee the medical education being conducted within the country. A brief account of the NMC from its date of establishment till the present is given here.

Modernising the National Health and Medical Research Council

The NHMRC is at a fork in the road - which route will the government take?

Joint commissioning and the evaluation of NHS reforms

It is a constant irony, or indeed frustration, that making steady and sure advances in changing the systems and processes of management can mean not a greater synergy in the relationship between systems, but rather a greater disparity. Such could be said of the NHS reforms and joint commissioning, although many of the concepts of NHS reforms should be conducive to achieving more success in joint commissioning. Joint commissioning involves assessment and planning for health and social sciences across a number of public and voluntary agencies.

A model for coordinating school health promotion programs

This paper presents an empirically developed model for coordinating the planning and implementation of combined health promotion activities for elementary schools. Validity of the model was assessed using results of semi-structured interviews with two individuals who served in the coordinator role. The amended model that was developed in light of the assessment is presented, with suggestions for others who seek to use a coordinated approach for increasing the impact of school health programs.

The changing role of CHCs (community health councils)

Peter Dunham and Sally Smith have experienced at first hand the changing role of community health councils and the opportunities that exist for collaborative working arrangements. Here, they define the progress that can be made in a relatively short period of time when empathy and trust exists between a CHC and its local health authority.

The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective

Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful.

Planning acute psychiatric services: a survey of current practice

Several factors have combined to make planning for acute psychiatric inpatient services an important concern of health planners. We report on a nationwide survey of the planning methods used by state health planning agencies to certify need for acute psychiatric services. The results indicate that very few state agencies have developed sophisticated planning methods. The majority use simple bed-to-population ratios, which vary widely from state to state, or rely on past utilization to predict future demands. One-fourth of the states have no method for determining need. The implications of these findings for informed, meaningful planning of psychiatric services are discussed.