Health systems model for chronic disease secondary prevention in rural and remote areas - Chronic disease: Road to health.

Objectives Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health . Conclusion A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes.

A case study in strategic change: developing a strategic research program to address cardiovascular disease and related disorders in aboriginal and Torres Strait Islander peoples and rural and remote settings.

This paper presents an analysis of a strategic change process. It identifies and reviews the critical factors that impact on, and need to be considered in order to successfully initiate and implement change. The problem was the narrow focus and priorities of a well-established research program. We undertook a stringent process to refocus the program to the areas of greatest need. The paper provides information on the process undertaken to achieve the change and other factors that impacted. The outcome has been considered successful in the first instance. However the long-term picture may not be as positive. Reviewing and presenting the process and influential factors provides the reader with the opportunity to compare this scenario with their own experience and thereby develop their own change strategies.