2013
DOI: 10.1097/hcr.0b013e31829b6e81
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A Comparison of Barriers to Use of Home- Versus Site-Based Cardiac Rehabilitation

Abstract: STRUCTURED ABSTRACTPurpose-Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. It is unknown whether patient barriers to enrollment and adherence are addressed by offering choice of program type. The purpose of this study was to examine barriers to participation in CR by program type (site vs. home-based), and the relation of these barriers to degree of program participation and exercise behavior.Method-1809 cardiac patients from 11 hospitals across Ontario … Show more

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Cited by 41 publications
(42 citation statements)
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“…Home cardiac rehabilitation can be administered remotely and has the potential to better meet the needs of rural patients, patients with work or caregiving responsibilities, or those served by facilities without an existing cardiac rehabilitation center. 30, 31 However, home-based programs are unlikely to be widely adopted unless payment reform is enacted to include reimbursement for non-traditional cardiac rehabilitation. Medicare is considering programs for incentives to hospitals based on cardiac rehabilitation participation and bundled payment initiatives with an aim toward reducing rehospitalizations, at least in part by increasing use of cardiac rehabilitation.…”
Section: Discussionmentioning
confidence: 99%
“…Home cardiac rehabilitation can be administered remotely and has the potential to better meet the needs of rural patients, patients with work or caregiving responsibilities, or those served by facilities without an existing cardiac rehabilitation center. 30, 31 However, home-based programs are unlikely to be widely adopted unless payment reform is enacted to include reimbursement for non-traditional cardiac rehabilitation. Medicare is considering programs for incentives to hospitals based on cardiac rehabilitation participation and bundled payment initiatives with an aim toward reducing rehospitalizations, at least in part by increasing use of cardiac rehabilitation.…”
Section: Discussionmentioning
confidence: 99%
“…Of patients who receive a physician referral to Phase II CR, only 30% to 34% enroll and participate (Mazzini, Stevens, Whalen, Ozonoff, & Balady, 2008;Suaya et al, 2007). There are multiple predictors of poor participation in Phase II CR, including lack of physician referral (CortĂ©s & Arthur, 2006;Gurewich, Prottas, Bhalotra, Suaya, & Shepard, 2008) or perceived low levels of physician endorsement (CortĂ©s & Arthur, 2006;Tsui, Shanmugasegaram, Jamnik, Wu, & Grace, 2012), lower socioeconomic status, limited education, racial/ethnic minority status (Valencia, Savage, & Ades, 2011), travel constraints (McDonall, Botti, Redley, & Wood, 2013;Shanmugasegaram, Oh, Reid, McCumber, & Grace, 2013), a preexisting home-based exercise routine (Shanmugasegaram et al, 2013), advanced age (McDonall et al, 2013), female sex (Beckstead et al, 2014;McDonall et al, 2013), being unpartnered (McDonall et al, 2013, and depression (McGrady, McGinnis, Badenhop, Bentle, & Rajput, 2009).…”
Section: The State Of Cardiac Rehabilitation (Cr) Exercisementioning
confidence: 99%
“…Home-based CR exercise optimally takes the form of a structured program that establishes clear guidelines for patients and may include monitoring and follow-up visits with health care professionals either in person (Balady et al, 2011) or via telephone or Internet (Shanmugasegaram et al, 2013). Many patients who participate in a home-based CR program report doing so because of barriers to participating in a hospital-based Phase II CR program, including travel constraints or a preexisting exercise routine (Shanmugasegaram et al, 2013).…”
Section: The State Of Cardiac Rehabilitation (Cr) Exercisementioning
confidence: 99%
“…The CR adherence tool, while valid, does not consider factors that may impede initial enrolment. 20 The Cardiac Rehabilitation Barriers Scale (CRBS) is arguably the most widely administered, [21][22][23][24][25][26][27] comprehensive and psychometrically validated tool to assess patient barriers to CR enrolment and participation from the patient to health system levels. 28 It was developed following a review of the literature and revised with input from healthcare providers including CR staff.…”
Section: Introductionmentioning
confidence: 99%