Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention

Dahhan, Ali; Maddox, William R.; Krothapalli, Siva; Farmer, Matthew; Shah, Amit; Ford, Benjamin; Rhodes, M.; Matthews, Laurie; Barnes, Vernon A.; Sharma, Gyanendra K.

doi:10.1016/j.hlc.2015.02.006

Cited by 23 publications

(20 citation statements)

References 45 publications

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“…18, 34–55 The studies addressing potential CR solutions included 15 RCTs 27–29, 56, 58, 59, 62, 71, 72, 74–76, 78, 82, 83 and 16 observational studies. 57, 60, 61, 63–70, 73, 77, 79–81 The study selection process is described in more detail in Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org.…”

Section: Resultsmentioning

confidence: 99%

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Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Supervía

Medina‐Inojosa

Yeung

et al. 2017

Mayo Clinic Proceedings

164

148

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Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.

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Section: Resultsmentioning

confidence: 99%

“…65, 79 In addition, interventions that increase CR awareness among patients and health providers have been shown to increase referral and enrollment rates. 60, 62 …”

Section: Resultsmentioning

confidence: 99%

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Supervía

Medina‐Inojosa

Yeung

et al. 2017

Mayo Clinic Proceedings

164

148

View full text Add to dashboard Cite

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“…4 This helps them to determine the ideal time for making a downward referral decision. 48 No matter the reasons behind this phenomenon, giving more chances for doctors to help improve their understanding of downward referral is a good option for increasing the possibility of downward referral. Some ‡OR is a frequently used indicator for measuring the effect of independent variable on the response variable.…”

Section: Discussionmentioning

confidence: 99%

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Nong

et al. 2017

BMJ Open

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ObjectivesIn China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics.MethodsDoctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis.ResultsOnly 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population.ConclusionsTo increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system.

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“…To understand the barriers of phase II CR development and promote the development of CR, previous studies have been carried out on the barriers encountered by CR both in China and abroad. Studies abroad have investigated the barriers of CR delivery in already developed programs mainly focusing on exploring the factors affecting the referral rate, admission rate, and compliance of patients (6)(7)(8)(9)(10). These factors are multifactorial, including patient factors, those of healthcare providers, and medical system levels (9,(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Successful Implementation and Development of a Phase II Cardiac Rehabilitation Program: A China-Wide Cross-Sectional Study Tracking In-service Training Clinical Staff

Gong

Zhang

Ripley-Gonzalez

et al. 2021

Front. Public Health

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Background: Despite the benefits of cardiac rehabilitation (CR), phase II CR remains highly unavailable; the factors influential to the successful implementation and development of phase II CR programs have not been fully explored.Methods: A cross-sectional survey was completed by 168 nationwide clinical staff. Parameters associated with the successful implementation and development of phase II CR and the factors associated with the quality of CR were explored by multivariable logistic regression.Results: One hundred and eighteen of 168 respondents' institutions had successfully developed phase II CR programs, 41 of which delivered high-quality CR. Independent factors associated with successful implementation and development of CR were leadership support from hospital administrators, support from resident physicians, staff perception in CR increasing medical risk, and department type (cardiology vs. rehabilitation department). Independent factors associated with CR quality were the availability of “professional CR providers” and staff perceptions of CR improving physician–patient relationships. The medical system factors did not affect the development and quality of CR, including hospital level, funding type, academic type, general/specialized hospital, located city, medical insurance, the existence of a CR outpatient clinic and independent space, the availability of professional CR providers, staff structure, and the availability of regular training and standard procedure.Conclusions: The development and quality of a phase II CR program may benefit from factors including support from administrators and resident physicians, adequately training more CR providers, without viewing medical system factors as a major issue.

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Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention

Cited by 23 publications

References 45 publications

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions

Practices and attitudes of doctors and patients to downward referral in Shanghai, China

Successful Implementation and Development of a Phase II Cardiac Rehabilitation Program: A China-Wide Cross-Sectional Study Tracking In-service Training Clinical Staff

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