Journal
EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION & REHABILITATION
Volume 15, Issue 5, Pages 548-556Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HJR.0b013e328305df05
Keywords
cardiac rehabilitation; coronary artery disease; enrollment; patient factors; physician factors
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Funding
- Canadian Institutes of Health Research (CIHR) [MOP-74431]
- Ontario Women's Health Council/CIHR Institute Of Gender and Health
- Heart and Stroke Foundation of Ontario
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Background Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This Study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment. Design A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist). Methods Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites. Results Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03). Conclusion Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided. Eur J Cardiovasc Prev Rehabil 15:548-556 (C) 2008 The European Society of Cardiology
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