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The Role of Systematic Inpatient Cardiac Rehabilitation Referral In Increasing Equitable Access and Utilization.
MedLine Citation:
PMID:  22193933     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 χ. 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.
Authors:
Sherry L Grace; Yvonne W Leung; Robert Reid; Paul Oh; Gilbert Wu; David A Alter
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-21
Journal Detail:
Title:  Journal of cardiopulmonary rehabilitation and prevention     Volume:  -     ISSN:  1932-751X     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101291247     Medline TA:  J Cardiopulm Rehabil Prev     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
York University (Drs Grace and Leung), York Central Hospital Dr Wu), University of Ottawa Heart Institute (Dr Reid), Toronto Rehabilitation Institute and Sunnybrook Health Sciences Centre (Dr Oh), and Institute for Clinical Evaluative Sciences and Toronto Rehabilitation Institute (Dr Alter), Toronto, Ontario, Canada.
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