A Survey Regarding Factors Affecting Cardiac Rehabilitation

Referral by Physicians and Surgeons of Tertiary Care Centre Paper ID : 197

Table 3 : Sub-scale
INTRODUCTION Total participants [n=510] Result shows that cardiac specialists were more likely
N Mean SD P value
Ü Cardiovascular diseases (CVDs) are among the leading Excluded participants [n=358] to perceive CR programs to be of poorer quality than
Subscale 1 Cardiac specialist 59 15.51 2.837
causes of morbidity and mortality worldwide. Not willing to participate, Did Referral norms 0.050* primary care physicians
Primary care
not responded, other reasons 1, 2, 3, 6
physicians 93 14.68 1.883
Ü India has one of the highest burdens of cardiovascular
disease world wide. Participants who responded [n=152] Subscale 2 Cardiac specialist 59 19.56 3.738
Referral processes 0.000* Some factors are modifiable
Ü Over three quarters of the cardiovascular deaths take 4,5,7,8,9,10,11 Primary care
physicians 93 22.24 3.328
place in low & middle income countries. Self reported PACRR-R scale used to investigate
Subscale 3 Cardiac specialist 59 8.78 2.883
clinical factors & perceptions affecting referral Preference to manage By marketing CR site locations, provision of
Ü Cardiac Rehabilitation(CR) significantly reduces 0.155
independently Primary care
12, 13, 14 physicians 93 9.40 2.044 standardized referral forms, and ensuring
secondary cardiovascular events & mortality.
Scoring Subscale 4 Cardiac specialist 59 20.73 5.827 discharge summaries are communicated to primary
1= Stongly agree to 5 = Stongly Disagree Program related factors 0.610
Cardiac Primary care
15,15,16,17,18,19
physicians 93 21.16 3.576 care physicians may improve CR referral
Rehabilitation RESULTS
Table 1 : Participants Ü Results shows that there is less awareness about CR in FUTURE RECOMMENDATION
Participants N (%) both groups yet cardiac specialists comparatively less Ü To plan various stratergies to reduce barriers in CR
Evidence-based intervention Improves subsequent Cardiac Specialist 59 (38.82) aware about CR referral
has been shown to reduce prognosis following coronary Primary Care Physicians 93 (60.78) Ü There is significant difference in subscale 1 and subscale 2
Ü To bring about local awareness of CR program among
morbidity and mortality events and procedures Total 152 between groups [p< or=0.05]
the team
Table 2 : PACRR-R scale Ü This suggests that referral is more standard in cardiac
Despite proven benefits, CR remains underutilized due to
Cardiac Primary
care specialists but, they were more likely to have lack of LIMATATIONS
Mean P value
combinations of factors (SD) Mean
(SD)
familiarity with CR sites, lack of standardize referral Ü Sample size was small
1. Clinical practice guidelines promote referral to CR* 4.31(0.77) 4(0.61) 0.001*
Patient Healthcare Ü Randomization was not done
Physicians form & incovinience
related factors System 2. My colleagues generally refer patients to CR* 3.69(1) 3.75(0.87) 0.932

3. My department/practice generally refers all eligible patients to

3.81(0.96) 3.48(0.84) 0.014* DISCUSSION CLINICAL IMPLICATION
CR as a standard of care* (e.g.,automatic referral)
Ü to raise awareness, healthcare providers should
Leads to low CR referral 4. Reimbursement policies are a financial disincentive to CR referral 2.61(1.83) 3.09(1.09) 0.036* CR programs have evidence
Yet all eligible patients engage in ongoing education regarding the benefits of
5. Follow-up care, including referral, is handled by another
2.93(1.08) 3.16(1.15) 0.164 based beneficial effects
Ü Studies shows that greatest barriers were related to lack of healthcare professional
are not referred
for cardiac patients CR , implement referral protocols and foster
awareness and encouragement by physicians for CR. 6. I generally intend to refer patients to CR* 3.69(0.99) 3.44(0.9) 0.078
collaboration among multi disciplinary teams.
7. I am not familiar with the CR programs in my area 2.97(1.46) 3.14(1.02) 0.845
Ü In India only 35% of cardiac patients are referred to CR by
8. I am not familiar with CR sites outside my geographic area 2.54(1.26) 3.2(0.96) 0.000* Many factors are present that culminate in REFERENCES
providers.
9. There is no standard referral form for CR, making it more effort 2.22(0.93) 3.02(1.07) 0.000*
under referral including 1. Grace, Sherry L. PhD; Grewal, Keerat BSc; Stewart,
Ü However, there are many few studies has explicitly to refer to sites closest to patient's homes
Donna E. MD. Factors Affecting Cardiac Rehabilitation
examined what different perceptions and barriers cardiac 10. An allied health professional fills out referral forms on my behalf* 2.93(1.26) 3.4(0.99) 0.021*

3.36(1.23) 3.23(1.12) 0.348 Geographical inaccessibility, R e f e r r a l b y P h y s i c i a n S p e c i a l t y. J o u r n a l o f

specialists versus primary care physicians may have. 11. It is inconvenient to make a referral to CR

12. I prefer to manage my patients' secondary prevention myself 2.68(1.24) 3.12(1.12) 0.022* Gaps in continuity of care, Cardiopulmonary Rehabilitation and Prevention 28(4):p
AIMS & OBJECTIVES 248-252, July 2008
13. I have patient education materials in my office that are sufficient
for promoting behavioural change
3(1.22) 3.12(0.99) 0.734 Nonstandardized referral practices,
Ü To find out the factors affecting cardiac rehabilitation 2. Sherry L Grace et al. Physician management preferences
14. I can prescribe an exercise regimen for my patients myself 3.1(1.26) 3.16(1.05) 0.757
Meagre marketing of sites and locations,
referral by physicians and surgeons of Ahmedabad. for cardiac patients: factors affecting referral to cardiac
15. I don't want to spend my time referring, as my patients are not Patient nonadherence, lack of awareness,
3.75(1.03) 3.35(0.94) 0.012*
Ü To compare factors affecting CR referral in primary care motivated to go or to exercise
rehabilitation. Can J Cardiol. 2004 Sep.
Physicians behavior
physicians versus cardiac specialists. 16. I am skeptical about the benefits of CR for my patients 3.27(1.35) 3.31(0.92) 0.921
3. Abraham Samuel Babu, PhD,1 Karam Turk-Adawi,
17. The available CR program is of poor quality 3.68(1.22) 3.61(0.92) 0.315
METHODOLOGY PhD,2 Marta Supervia, MD et al. Cardiac Rehabilitation
18. I have had a bad experience with a CR program (e.g., patient
reported dislike, did not received discharge summary, patient had 3.63(1.32) 3.68(0.81) 0.340
This study show some of of the different factors in India: Results from the International Council of
adverse event, program changed medications)
Ü Study type: A Cross-sectional Survey affecting the CR referral practices of cardiac Cardiovascular Prevention and Rehabilitation’s Global
19. Patients have too many barriers to attend CR (e.g., can't pay for,
Ü Sample size: 510 3.31(1.28) 3.43(1.03) 0.720
distance, time conflicts), so there is no point in referring them specialists & primary care physicians Audit of Cardiac Rehabilitation. Glob Heart. 2020; 15(1):
Ü Sample design: Convenience sampling 20. I often have concerns about safety or risk in CR related to my
3.1(1.28) 3.77(0.91) 0.001* 28. Published online 2020 Apr 3
patient's clinical status