"I'm still waiting...": barriers to accessing cardiac rehabilitation services

Background: The United Kingdom (UK) National Service Framework for coronary heart disease challenges health services to address existing problems regarding the quality and content of cardiac rehabilitation services. Concern also exists regarding inequalities in access to services. The South Yorkshire Coalfields Health Action Zone (SYCHAZ) funded this study to harness the views and experiences of staff and patients regarding existing services. The intention is to use the information gained to develop acceptable and accessible services for the future. Aims: To explore what barriers exist for patients in accessing cardiac rehabilitation services within the South Yorkshire Coalfield locality. Ethical issues and approval: Patients were identified and recruited with the assistance of staff responsible for their care. Informed consent was obtained prior to participation. Approval was obtained from the relevant Ethics Committees. Methods: Qualitative methods were used, including semi-structured interviews and Framework Analysis techniques. Purposive sampling was used to select participants. Instruments: Semi-structured individual interviews of 15 staff and 20 postmyocardial infarction patients. One group interview with seven health visitors and two with lay members of heart support groups. Outcomes: Barriers to accessing cardiac rehabilitation. Results: This study revealed a limited service capacity. Big gaps exist between patches of service activity that most patients appear to slip through. Problems in accessing the service were categorized into five themes: absence, waiting, communication, understanding, and appropriateness. Some groups fared worse in terms of access to services, for example women, the elderly and those in traditional working class coalfields communities. Professional and more affluent participants appeared better able to negotiate their way around the system by seeking out advice or 'going private'. Limitations: The omission of medical staff and ethnic minority patients. Conclusions: Cardiac rehabilitation in the policy targets in UK will only be met with substantial investment to address the barriers identified here.