A Contemporary Phone-Based Cardiac Coaching Program: Evolution and Cross Cultural Utility.

BACKGROUND: The Hospital Admission Risk Program (HARP) Cardiac Coach Program at Royal Melbourne Hospital has evolved to include a Greek and Italian service, developed in response to the diverse local community and supported by evidence that Culturally and Linguistically Diverse (CALD) groups both perceive health and respond to health care services and information, differently. This paper aims to evaluate if a phone-based cardiac coaching program can be adapted to the Greek and Italian populations using the English cohort as a comparator. METHODS: We retrospectively analysed cardiovascular risk profiles at recruitment into and at discharge from the program. Patients (n=383) were recruited after an acute coronary event or intervention between June 2011 and June 2013. Recruitment was into the English (n=301 patients (79%)) Greek (40 (10%)) or Italian (42 (11%)) model. Data was collected on demographic information and risk factor status at entry and discharge from the program: waist circumference, weight, height, lipid profile, HbA1c, smoking status and physical activity. A comparison of the proportion of patients meeting the defined targets across the English, Italian and Greek cohorts was performed, with multivariate logistic regression analysis applied to adjust for differences in baseline variables. RESULTS: There were baseline differences in age, smoking history, total cholesterol and cholesterol fractions, diastolic blood pressure, weight and physical activity between the cohorts. At discharge, the proportion of patients meeting targets within each cohort were similar. CONCLUSION: A phone-based integrated disease management program can be adapted to CALD patients, achieving comparable outcomes as compared with an English-speaking cohort. Health services need to respond to their local needs and be flexible in program delivery in order to benefit as many patients as possible.

Evaluation of the Effectiveness of a Phone Based Care Coordination Pilot on Hospital Utilisation and Costs for Patients With Chest Pain.

BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the ED after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain. METHODS: A longitudinal, single-arm interventional study with retrospectively recruited control group. Ninety-five patients were enrolled as the intervention group; 97 patients were retrospectively identified as controls. These patients had re-presented with chest pain within 6 months of a cardiac event, or attended hospital within 12 months two or more times with chest pain and/or complex needs. Intervention group patients were holistically assessed then phone-coached to support self-management of chest pain over 6 months. Following descriptive and univariate analysis, multivariate analysis was conducted to adjust for noted differences between the intervention and control groups. RESULTS: Thirty-day representation to ED was significantly less for the intervention group (14.1%) compared to controls (27.7%). After adjusting for baseline differences, intervention patients were more than two-fold less likely to re-present compared to controls (OR=0.42, 95%CI: 0.19-0.96). After adjustment for baseline differences, the savings in subsequent inpatient costs was $1588 per person, as a result of intervention, patients were less likely to have inpatient readmissions (16.3%) compared to controls (20.2%), although this was not statistically significant (p=0.588). CONCLUSION: A phone based care-coordination pilot with targeted interventions has the potential to reduce ED presentations and hospital readmissions among patients representing with chest pain.