OC06_04 Effectiveness and Safety of Exercise Training in Children With Congenital Heart Disease

Abstract

R A L A B ST R A C T S and facilitators of EBM use among countries of different incomes may allow innovative approaches to be developed to optimize cardiovascular disease (CVD) prevention. Objectives: To compare and contrast barriers and facilitators of EBM use for the secondary prevention of CVD. Methods: A qualitative multiple case study approach was implemented in two settings, Hamilton, Canada and Delhi, India. A purposeful sample (n1⁄461) of 23 patients, 14 physician/nurse practitioners, 10 pharmacists, 3 nurses, 1 social worker, 4 hospital administrators, 2 NGOs and 4 policy makers partook in in-depth interview in Hamilton, Canada (n1⁄420) or Delhi, India (n1⁄441). All interviews were digitally recorded and transcribed for analysis using directed content analysis. Results: The overarching themes that emerged across the stakeholder groups included: 1) Medication counselling; 2) Monitoring adherence; 3) Medication affordability and drug coverage; 4) Time restrictions; 5) Task shifting and capacity building; and 6) Family support. Medication counselling was primarily verbal in both contexts with healthcare practitioners (HCPs) in India failing to communicate critical information about EBM. Medication unaffordability was more prevalent in the Canadian patients with poor/low usage rates of government-subsidized drug programs. Despite Universal Health Coverage in India, access to affordable medications was limited by regulations to qualify for coverage under the program. High patient loads were reported in both countries resulting in inadequate care. Redistribution of medication renewal and titration to reduce physicianburden was supported by HCPs in Canada. Conversely, task-shifting the management of medications was opposed by physicians in India with many expressing concern over the level of clinical expertise required to execute these tasks. Conclusion: Our findings highlight the interplay of various, context-specific factors which affect the patient’s decision to initiate and/or continue CVD medication. We recommend implementation of multidisciplinary approaches incorporating above mentioned themes to facilitate improvements in EBM use. Disclosure of Interest: None Declared