Table 5 Social ecological model
Level of influence | Barriers | Potential solutions |
|---|---|---|
Individual | Healthcare professional | • Establishing inter-professional collaboration forums (e.g. working groups, knowledge-sharing meetings) |
• Developing collaborative relationships between health professionals looking after HF patients | ||
Microsystem | The organisation of CR programmes | • Using new delivery systems such as telemedicine |
• Providing choice between hospital-based group rehabilitation and home-based individual programmes | ||
• Providing feedback to programmes regarding the management of their HF patients | ||
Mesosystem | The organisation of healthcare system | • Providing integrated healthcare |
• Developing local patient pathways | ||
• Using automatic referral systems | ||
Exosystem | Education | • Education programmes for healthcare professionals on the importance of exercise training |
Medical insurance | • Better collaboration with healthcare authorities | |
• Increasing insurance coverage | ||
Resources | • Inclusion of CR for HF in local commissioning contracts | |
• Changes to healthcare systems that improve access to CR by removing some of the financial constraints (such as accountable care organisations under the new Affordable Care Act in the United States) | ||
Macrosystem | The origins of CR and previous practices | • Initiatives influencing awareness of the importance of CR (e.g. the Cardiac Rehabilitation Network of Ontario) |
Evidence-base | • Increasing the evidence-base confirming the benefits and safety of CR in patients with HF (especially HFpEF) | |
Guidelines | • Development of cross-institutional guidelines | |
• Combining and translating guidelines into clinical algorithms (to reduce practice variation and increase guideline adherence) | ||
• Better implementation of existing guidelines |