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Cardiac Rehabilitation With Nurse Care Management and Telephonic Interactions at a Community Hospital: Program Evaluation of Participation and Lipid Outcomes

Harris, David E. PhD, BSN; Record, N. Burgess MD; Gilbert-Arcari, Jane LPN; Bunnell, Sheena PhD; Record, Sandra S. RN; Norton, Katherine BA

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Cardiac rehabilitation (CR) can help patients with heart disease control some risk factors, limit new coronary artery lesions, and decrease death rates. However, participation rates in CR are low. Using a descriptive design, we evaluated a modified CR program in which nurse care managers used telephonic communication with patients in their homes by comparing it to a traditional CR program in a hospital setting. Using multivariate analysis we compared the patient cohorts eligible for each of the programs, and program participants to the nonparticipants for each program. Compared to traditional CR, the modified CR program with nurse care management was associated with significantly improved participation rates (11% vs. 22%) and the apparent overcoming of several well-described barriers to CR participation (distance from the hospital and domestic isolation). Risk factor management, including testing of serum lipids and achieving goals for lipid reduction, for participants in both CR programs was superior to risk factor management for nonparticipants.

David E. Harris received his BSN from Salem State College in 1975 and his PhD in Physiology and Biophysics from the University of Vermont Medical School in 1990. He is currently Associate Professor of Natural & Applied Sciences at Lewiston-Auburn College, University of Southern Maine, where he teaches Anatomy & Physiology and Pathophysiology to students of nursing. Dr Harris’s research interests are in the assessment of programs to prevent the complications of heart disease.

Burgess Record, MD, FCSS, has practiced internal medicine since 1973. He directed the Franklin Cardiovascular Health Program from 1974–1997 and was Director of Preventive Cardiology at Maine’s VA hospital from 1991–1996. He is currently the Director of the Western Maine Center for Heart Health, a cardiovascular health consultant to Maine’s Bureaus of Health and Medical Services, and a director of the Maine Cardiovascular Health Council.

Jane Gilbert-Arcari received her LPN from the Albany Medical Center School of Nursing in 1969. She has worked as a clinical nurse in obstetrics, medical/surgical units, intensive care units, and emergency rooms. She has also been a cardiovascular disease prevention counselor, a tobacco cessation counselor, and a hospital computer specialist responsible for database and Web site development.

Sheena Bunnell received her PhD in Economics from Florida State University in 1995. She is currently the Director of the Maine Health Research Institute, and Associate Professor of Business and Economics at the University of Maine at Farmington. Dr. Bunnell’s research interests are in applied economic policy analysis. Recently she codeveloped the budget neutrality cost model that enabled individuals infected with HIV in Maine access to care under the nation’s first HIV Medicaid waiver.

Sandra S. Record received her RN from the Maine Medical Center School of Nursing in 1963. She has been a cholesterol control clinic patient care manager and the Community Wellness Program Director for Franklin Memorial Hospital, and has served on the national faculty for the AHA “Get With the Guidelines” program. Ms. Record is currently the Program Director of the Western Maine Center for Heart Health, Farmington.

Katherine A. Norton received her BA degree from the University of Maine at Farmington in 1999. She worked as a research assistant for the Cardiovascular Health Research Group of Franklin Memorial Hospital and the Maine Health Research Institute from 2000–2001. Ms. Norton is currently pursuing a graduate degree in physical therapy.

Address correspondence and reprint requests to David E. Harris, PhD, BSN, Lewiston-Auburn College, University of Southern Maine, 51 Westminster Street, Lewiston, ME 04240 (deharris@usm.maine.edu).

© 2003 Lippincott Williams & Wilkins, Inc.