This paper documents the feasibility, clinical impact and cost-effectiveness of a local clinician-led Exercise Tolerance Test (ETT) service provided through Ministry of Health Rural Innovation Funding for two rural communities (Rawene in Northland and Dunstan in Central Otago) over 12 months from September 2011. Over the study period, 33 ETTs were performed at Rawene Hospital and 202 at Dunstan Hospital. An audit of ETT reports that calculated the direct costs of the service including doctor and nurse time, equipment costs, consumables, and cardiologist/physician oversight revealed that the cost per test at both Rawene ($200.00) and Dunstan ($132.50) was considerably less than the national price of $281.13 in 2012 (community referred tests-cardiology). Nearly all of the patients referred to these rural services would otherwise have been referred to specialist cardiology services. Instead, the majority of patients (83% at Dunstan and 70% at Rawene) did not require onward referral to specialist services; the ETT result enabled the GP to continue to manage the patient in primary care. In cases where the ETT indicated specialist treatment, this was provided in a timely manner. The study researchers conclude that this collaborative approach to delivering ETT services in rural communities is sustainable, cost effective, improves access for rural patients and may help overcome inequities across New Zealand in terms of access to cardiac investigations and early, appropriate treatment.
