The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend that every cardiac and pulmonary rehabilitation program becomes nationally certified to ensure strict standards of patient care and quality programming. This investigation was conducted to update Arizona Society of Cardiovascular and Pulmonary Rehabilitation (ASCVPR) records of the number of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) programs that were AACVPR certified in Arizona (AZ). A delegated ASCVPR representative provided a record of programs that offered early outpatient CR and PR within the state. An updated record through March, 2014 was then compiled. There were 19 CR and 3 PR certified programs in AZ. According to ASCVPR records, 32 programs offered early outpatient CR. Eleven programs offered outpatient PR. This means that 59% of all early outpatient CR programs and 27% of PR programs in AZ were certified. In 2010, there were 11 certified CR programs, which was 32% of the 34 institutions offering CR at that time. It is recommended that the ASCVPR continues to routinely update their record of CR and PR programs and that initiatives be developed to assist programs in the certification process.
Motivational interviewing (MI) is a method of communication that can significantly improve the health behaviors of cardiac rehabilitation (CR) patients. However, healthcare provider (HCP) skill levels may vary, and MI proficiency is not typically measured in CR patient consultations. This study was designed to assess MI proficiency during health education consultations in an outpatient CR program. Patients were given the Consultation and Relational Empathy (CARE) Measure immediately following a 30-minute CR consultation with a health educator who was trained in MI. The CARE Measure is a 10-item questionnaire that asks patients to anonymously assess the level of empathy that is expressed by a HCP during a consultation, which is considered to be a defining characteristic of MI. 411 questionnaires were completed and each item was scored on a 1-5 Likert scale (1=poor, 2=fair, 3=good, 4=very good, 5=excellent). In addition, five patient consultations were randomly selected and the patients gave permission for their consultations to be confidentially audiotaped and analyzed by a MI coding expert. The Motivational Interviewing Treatment Integrity 3.0 (MITI 3.0) Coding Instrument was used to score the consultations on global ratings that used a 1-5 scale, and an objective behavioral count that determines MI proficiency. The overall mean score for the CARE Measure was 47.6 (SD=4.4) out of a possible maximum of 50. The overall mean global rating score for the MITI 3.0 was 4.2 (SD=0.5) out of a possible maximum of 5. The mean global rating score for MI spirit was 4.1 (SD=0.5) and the mean global rating score for empathy was 4, where all consultations were scored the same. On the behavioral count, reflections outweighed questions with a mean reflection-to question ratio of 1.4. The mean percentage for MI adherence was 100%. In this study, the health educator demonstrated MI consistent behavior. It appears that the CARE Measure and the MITI 3.0 are assessment tools that can be used in CR to provide feedback on MI proficiency. Further investigation is needed to determine the relationship between MI proficiency and patient outcomes in CR.
Healthcare providers are challenged to motivate patients to become physically active during brief clinical consultations. In a randomized-control trial, we previously demonstrated that Motivational Counseling (MC) added to traditional cardiac rehabilitation significantly enhances physical activity and exercise. This investigation was conducted to determine the feasibility of applying research to practice by adding MC to daily practice within an established clinical setting. Brief MC sessions (wks 1, 2 & 7) conducted by a health educator were added to a 12-wk early outpatient cardiac rehabilitation program of exercise, education and medical support. One hundred and one patients (71% males) were assessed at baseline and 12 wks. Physical activity was quantified with the Lo-PAR; an interview-administered recall of the previous week’s sleep and activity at work, in the home and during recreation. Patients ranged in age from 33-91 (Mean=63, SD=13) years and had experienced a recent cardiac event (angina, myocardial infarction, angioplasty or bypass surgery). A dependent sample t-test indicated a significant mean difference between baseline and 12-wk physical activity scores (p<0.05). The mean physical activity score changed from 228 (SD=21) to 267 (SD=37) METhrs/wk. The proportion of patients classified as very inactive (<225 MET-hrs/wk) changed from 43% at baseline to 11% at 12 wks. Inactive-somewhat active patients (225-250 MET-hrs/wk) changed from 44% to 27%. Active patients (251300 MET-hrs/wk) changed from 13% to 50%. None of the patients were very active (>300 MET-hrs/wk) at baseline compared to 12% at 12 wks. The mean difference between scores for exercise alone was also significant from baseline to 12-wks (p<0.05). The mean exercise scores changed from 3 (SD = 4) MET-hrs/wk to 18 (SD = 12) MET-hrs/wk. It was concluded that it is feasible for a non-mental health specialist to successfully integrate MC into a clinical setting and significantly improve physical activity in the early phase of recovery from heart disease.
Cardiac health may be compromised by non-adherence to prescribed medication. Therefore, the Medication Adherence Scale (MAS; Brooks et al., 1994) was used to assess adherence in patients with coronary artery disease. The study comprised 61 patients (71% males) who had experienced a cardiac event 40 days (SD=37) days earlier. The MAS consisted of 4 yes-no questions about adherence over the previous 3 months. Thirty-four percent self-reported full adherence to prescribed medication. The most common reasons for nonadherence included forgetfulness (57%) and carelessness (26%). In patients who were feeling better, 5% stopped taking medication and 7% took less than prescribed. It appears that the MAS may be a worthwhile method of identifying non-adherence to medication in patients with coronary artery disease.