What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiac rehabilitation indication (n=326). Intervention: Cardiac rehabilitation wait times vs. Consensus recommendations. Primary outcome: Patient-reported wait time from hospital discharge to cardiac rehabilitation initiation.

May 1, 2012Open Access

Perceptions of Cardiac Specialists and Rehabilitation Programs Regarding Patient Access to Cardiac Rehabilitation and Referral Strategies

SGSherry L. GracePreventive Cardiology YTYongyao TanUniversity of Auckland CSChris SimpsonUniversity of San Diego

Key Result

Patients reported a median wait time of 42 days from hospital discharge to cardiac rehabilitation initiation, which exceeds the 30-day consensus benchmark, yet 91.5% considered their wait acceptable.

Study Design

Type

Cross-Sectional (n=326)

Multicenter

Yes

Structured PICO

What are the perceptions of cardiac specialists and rehabilitation programs regarding patient access to cardiac rehabilitation and referral strategies?

Population

163 cardiac rehabilitation enrollees (mean age 62.8 years, 21.5% female), 71 cardiac specialists, and 92 rehabilitation programs in Canada surveyed regarding actual and ideal wait times for cardiac rehabilitation.

Exposure

Postal and online surveys evaluating perceptions of cardiac rehabilitation access and referral strategies

Outcome

Perceptions of cardiac rehabilitation access and referral strategies rated on 5-point Likert scales

Effective referral strategies like electronic referrals are underutilized, and broader implementation along with better resourcing of CR programs may improve patient access to cardiac rehabilitation.

Limitations

Low response rate to the cardiac specialist survey (9.3%) limiting generalizability
Reliance on self-reported perceptions of wait times which may introduce estimation error
Multiple comparisons between specialist and program perceptions may have resulted in inflated error rates
Cross-sectional design precludes causal conclusions

Abstract

In Brief BACKGROUND: Access to cardiac rehabilitation (CR) remains at approximately 30%, despite a national target of 70%. This study evaluated cardiac specialist and CR program perceptions of CR access and referral strategies. METHODS: Postal and online surveys of Canadian CR specialists and CR programs were administered. Responses were received from 71 of 765 CR specialists (9.3%) and 92 of 149 CR programs (61.7%). Respondents rated perceptions on 5-point Likert scales. RESULTS: Specialists rated patient access to CR as moderate (2.9 ± 1.4). While they reported that they refer 65.9% of their patients, they most frequently do not refer because their patients report disinterest (23.4%) or geographic barriers to access (23.4%). Cardiac rehabilitation programs reported having capacity to serve a median of 275 patients annually, yet reportedly serving up to 350. The most commonly used methods of referral included discharge order sets (over 60%) and allied health care provider support. Electronic referral was perceived to be highly effective (4.1 ± 1.0) yet the least frequently used. Cardiac rehabilitation programs perceived more patients are accessing CR because of these referral strategies, but increased patients strain program resources. CONCLUSIONS: Some of the least frequently used referral strategies were perceived as, and are also empirically demonstrated to be, most effective. Broader implementation of these strategies, while better-resourcing CR programs, may improve the continuum of care for cardiac patients. This national assessment of cardiac rehabilitation (CR) access from the vantage point of specialists and programs revealed that access might be limited by infrequent application of effective referral strategies, patient report of disinterest or geographic barriers to physicians leading to referral failure, and lack of CR program funding and capacity.

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