Journal
JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION
Volume 32, Issue 1, Pages 41-47Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HCR.0b013e31823be13b
Keywords
access to health care; cardiac rehabilitation referral; coronary artery disease; rural population; socioeconomic status
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Funding
- Canadian Institutes of Health Research Institute of Gender and Health (CIHR IGH)
- Heart and Stroke Foundation of Canada [HOA-80676]
- CIHR Institute of Health Services and Policy Research (IHSPR) [MSH-80489]
- CIHR Canada
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BACKGROUND: While systematic referral strategies have been shown to significantly increase cardiac rehabilitation (CR) enrollment to approximately 70%, whether utilization rates increase among patient groups who are traditionally underrepresented has yet to be established. This study compared CR utilization based on age, marital status, rurality, socioeconomic indicators, clinical risk, and comorbidities following systematic versus nonsystematic CR referral. METHODS: Coronary artery disease inpatients (N = 2635) from 11 Ontario hospitals, utilizing either systematic (n = 8 wards) or nonsystematic referral strategies (n = 8 wards), completed a survey including sociodemographics and activity status. Clinical data were extracted from charts. At 1 year, 1680 participants completed a mailed survey that assessed CR utilization. The association of patient characteristics and referral strategy on CR utilization was tested using chi(2). RESULTS: When compared to nonsystematic referral, systematic strategies resulted in significantly greater CR referral and enrollment among obese (32 vs 27% referred, P = .044; 33 vs 26% enrolled, P = .047) patients of lower socioeconomic status (41 vs 34% referred, P = .026; 42 vs 32% enrolled, P = .005); and lower activity status (63 vs 54% referred, P = .005; 62 vs 51% enrolled, P = .002). There was significantly greater enrollment among those of lower education (P = .04) when systematically referred; however, no significant differences in degree of CR participation based on referral strategy. CONCLUSION: Up to 11% more socioeconomically disadvantaged patients and those with more risk factors utilized CR where systematic processes were in place. They participated in CR to the same high degree as their nonsystematically referred counterparts. These referral strategies should be implemented to promote equitable access.
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