scholarly journals Association of Veterans Health Administration Home-Based Programs With Access to and Participation in Cardiac Rehabilitation

2018 ◽  
Vol 178 (5) ◽  
pp. 715 ◽  
Author(s):  
David W. Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Claire S. Duvernoy ◽  
Daniel E. Forman ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Home Based

scholarly journals Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bonnie J. Wakefield ◽  
Kariann Drwal ◽  
Monica Paez ◽  
Sara Grover ◽  
Carrie Franciscus ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Qualitative Data ◽  
Document Analysis ◽  
Veterans Health Administration ◽  
Rehabilitation Program ◽  
Veterans Health ◽  
High Uptake ◽  
Health Administration ◽  
Home Based ◽  
Uptake Sites

Abstract Background Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. Methods This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. Results Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. Conclusion Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.

Abstract P300: Presence of Mental Health Conditions Associated With Greater Adherence to Home-Based Cardiac Rehabilitation

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nirupama Krishnamurthi ◽  
David Schopfer ◽  
Mary A Whooley
Keyword(s):  
Mental Health ◽  
Cardiac Rehabilitation ◽  
San Francisco ◽  
Health Conditions ◽  
Veterans Health ◽  
Health Administration ◽  
Logistic Regression Models ◽  
Mental Health Conditions ◽  
Primary Indication ◽  
Home Based

Introduction: Patients with mental health conditions have higher rates of ischemic heart disease but have been less likely than those without mental health conditions to participate in traditional (center-based) cardiac rehabilitation programs. We sought to examine the association of mental health conditions with rates of participation in (and completion of) home-based cardiac rehabilitation (HBCR). Methods: The Veterans Health Administration is developing new HBCR programs to improve access for patients with cardiovascular disease who are unable to attend traditional (center-based) programs. Among 323 hospitalized patients who were eligible and referred to cardiac rehabilitation at the San Francisco VA between 8/1/15 and 9/30/16, we evaluated the association of depression and/or PTSD (defined based on manual review of medical records) with participation in and completion of HBCR. Logistic regression models were used to adjust for patient demographics, primary indication for CR and comorbid conditions. Results: Of the 323 eligible patients referred to HBCR, 127 (39%) suffered from depression and/or PTSD. Participation rates were 41% (52/127) in patients with vs. 32% (62/196) in patients without depression or PTSD (p=0.09). Among the 114 patients who agreed to participate in HBCR, 52 (46%) suffered from depression and/or PTSD. Rates of completing 9 or more sessions were 67% (35/52) in patients with vs. 44% (27/62) in patients without depression or PTSD (p=0.01). After multivariable adjustment, patients with depression and/or PTSD had a 3-fold greater odds of completing HBCR than those without depression or PTSD (OR 2.85, 95% CI 1.14- 7.17; p=0.02). Conclusions: Among patients referred to cardiac rehabilitation, those with a history of depression and/or PTSD were equally likely to participate and significantly more likely to complete HBCR than those without depression and/or PTSD. These findings suggest that patients with mental health conditions may be especially likely to benefit from HBCR.

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

Sign in / Sign up

Export Citation Format

Share Document