Using GIS to Improve Accessibility to Phase 2 Cardiac Rehabilitation Programs Deborah van Gaans Centre for Research Excellence in the Prevention of Chronic Conditions in Rural and Remote Populations School of Population Health The research reported in this presentation has been supported by the Australian Primary Health Care Research Institute, which is supported by a grant from the Commonwealth of Australia as represented by the Department of Health and Ageing. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Commonwealth of Australia (or the Department of Health and Ageing).

An Australian Research Council Funded Linkage Project with the Following Collaborating Partners : The University of Adelaide - Mr. Neil Coffee Alphapharm Pty Ltd. - Mr. Peter Astles, Ms. Marian Milligan University of South Australia - Dr. Robyn Clark University of Queensland - Professor David Wilkinson, Dr. Kerena Eckert Monash University - Professor Andrew Tonkin The Baker Heart Research Institute - Professor Simon Stewart

The Problem Death by Major Cause, Group and Sex, 2008 (ABS Causes of Death, Australia, 2008).

The Answer : Cardiac Rehabilitation 1.Introduced into Australia by the National Heart Foundation in By 1986, cardiac rehabilitation had advanced sufficiently for it to be seen as an important component of cardiac care. 3.Defined benefits include reduced mortality and reduced risk of further cardiac events; improvements in physical and social functioning, risk factor profiles and quality of life; and reduced prevalence of depression. Source: Bunker, S,J, and Goble, A, J 2003, ‘Cardiac rehabilitation: under-referral and underutilisation’, MJA 2003; 179 (7):

The Bigger Problem! Despite the evidence to support cardiac rehabilitation, existing services remain underutilised. Accessibility is a major factor in the underutilisation of Phase 2 Cardiac Rehabilitation Programs.

Do Patients Access Their Nearest Cardiac Rehabilitation Program? 5 Phase 2 Cardiac Rehabilitation Centres provided information: Royal Adelaide Hospital, Flinders Medical Centre, Northfield Centre for Physical Ageing, Lyell McEwin Hospital, Queen Elizabeth Hospital. 2007/2008 only. 857 patients. Patient addresses were shortened to street and suburb only to maintain confidentiality.

Patient Locations and Cardiac Rehabilitation Programs

Calculating Nearest Cardiac Rehabilitation Program

Patients Attending Nearest Cardiac Rehabilitation Program 571 attending nearest 286 not attending nearest Total 857 patients

Source: Cromley, EK, McLafferty, SL, 2002, ‘GIS and Public Health’, The Guilford Press, New York, pp In reality, people trade off geographical and nongeographical factors in making decisions about health service use (Cromley and McLafferty 2002).

Source : Penchansky, R, Thomas, JW 1981, ‘The Concept of Access: Definition and Relationship to Consumer Satisfaction’, Medical Care, vol. 19, no. 2, pp Penchansky and Thomas (1981) identify five important dimensions of access: 1.Availability 2.Accessibility 3.Accommodation 4.Affordability 5.Acceptability

Addresses of Cardiac Rehabilitation Programs were obtained from the Australian Cardiac Rehabilitation Association. Pilot survey undertaken via . 2 postal surveys were conducted. Follow-up phone calls were made to non-respondents % return rate. Cardiac Rehabilitation Accessibility Survey

The Accessibility of Phase 2 Cardiac Rehabilitation

“This is highlighted by the fact that attendees lived an average of 15.4km from the facility providing the CR program whereas non-attenders lived an average of 40.4kms from the facility.” De Angelis (2008)

The Accessibility of Phase 2 Cardiac Rehabilitation to Rural and Remote Population Centres as Defined by ARIA

Model validation Patients with higher accessibility ratings from the Spatial Model of Accessibility to Phase 2 Cardiac Rehabilitation were found to have been more likely to have attended cardiac rehabilitation (Pearson Correlation (P>0.0001, 95% CI to ).

Conclusion GIS was used to throughout this project: to highlight the initial problem to create a model for better understanding of the current situation to validate the model And most importantly to highlight where improved accessibility to Phase 2 Cardiac Rehabilitation Programs should occur.

Deborah van Gaans Centre for Research Excellence in the Prevention of Chronic Conditions in Rural and Remote Populations School of Population Health Thank you