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Evaluation of a rural primary-referred cardiac exercise tolerance test service.

AIM
To describe the feasibility, clinical impact and cost-effectiveness of a rural generalist-led cardiac exercise tolerance test (ETT) service for primary care patients in two different rural communities.


METHOD
For 12 months, from Sept 2011, a generalist-led ETT service was provided in two rural hospitals in New Zealand: Dunstan in Central Otago and Rawene in Northland. Data was collected to describe the patient outcomes of this service. An audit of ETT reports and financial and rural-urban analyses were undertaken.


RESULTS
The cost per test of the local ETT service at Dunstan, ($132.50), and Rawene, ($200.00), was less than the national price ($281.13 in 2012). The majority of patients (83% at Dunstan and 70% at Rawene) were not referred to specialist services; the ETT result allowing the GP to continue to manage the patient in primary care. Where the ETT indicated specialist treatment, this was subsequently provided in a timely manner.


CONCLUSION
ETT can be provided cost-effectively in a variety of rural settings. Improved access to ETT for rural communities may help address inequities across New Zealand in terms of access to cardiac investigations and early and appropriate treatment.