(P210) BREAKING BARRIERS: A MULTIDISCIPLINARY APPROACH & SYSTEMATIC FRAMEWORK TO INCREASE ACCESS FOR NUNAVUT RESIDENTS TO CARDIOVASCULAR REHABILITATION

Background: Cardiovascular rehabilitation (CR) programs are underutilized across Canada with a known under representation from minority groups such as Indigenous peoples (Grace, S. et al, 2014). The sheer geographic inaccessibility, the unique cultural, and historical factors continue to limit access to cardiovascular care for this population (Marchand, M. et al, 2023).
In 2022, a systematic referral process review was initiated in our cardiac tertiary institution, in response to a notable lack of enrollment of less than 5% of patients from Nunavut to our CR programing. Acknowledging common barriers for Indigenous patients such as low incomes, extended family responsibilities, cultural appropriateness, and the links between colonialism and healthcare (Hamilton, S. et al, 2016), was the first step to address access inequity.

METHODS AND RESULTS: The existing practice to identify Nunavut residents in our institution was modernized by creating a dashboard overview in our electronic medical record system to sort patient identifiers by province.
Once identified, CR staff visited eligible patients at bedside to provide an invitation to participate in CR, as opposed to a letter sent to a case manager to coordinate post discharge.
Capitalizing on this opportunity to interact with patients and families, CR staff provided education including program streams, acknowledging barriers to participate such as length of stay in hospital, access to technology and nearest heath center within their community. Alternative appointment options were created and offered to help improve accessibility.
Sensitivity training was provided for CR staff and culturally appropriate resources such as individualized exercise programs and lifestyle recommendations were developed with patient partners. Monthly tracking of the eligible patient enrollment to CR was implemented to assess program outcomes.
Since the implementation of this multidisciplinary approach and systematic framework, referrals to CR increased 160%, in addition we achieved a 24% CR enrollment of Nunavut Residents attending first CR appointment compared to less than 5% within one year.

Conclusion: Bi-weekly rounds on inpatient wards to interact with the multidisciplinary team and continued engagement among CR and inpatient staff was integral to increase enrollment.
For this program to have continued success, tailored programing needs to be part of best practice. Continued engagement with community partners, providing culturally sensitive education and resources to all indigenous populations is essential to break the barriers to this disparity that continues to exist among healthcare services accessed by marginalized populations.