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Cardiologists' charting varied by risk factor, and was often discordant with patient report.

https://arctichealth.org/en/permalink/ahliterature157753
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Publication Type
Article
Date
Oct-2008
Author
Shannon Gravely-Witte
Donna E Stewart
Neville Suskin
Lyall Higginson
David A Alter
Sherry L Grace
Author Affiliation
University Health Network Women's Health Program, 200 Elizabeth St., Toronto, Ontario, Canada. sgravely@yorku.ca
Source
J Clin Epidemiol. 2008 Oct;61(10):1073-9
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - epidemiology - etiology
Clinical Competence
Diabetes Mellitus - epidemiology
Dyslipidemias - complications - epidemiology
Epidemiologic Methods
Female
Humans
Hypertension - complications - epidemiology
Male
Medical Records - standards
Middle Aged
Ontario - epidemiology
Outpatient Clinics, Hospital
Self Disclosure
Smoking - adverse effects - epidemiology
Socioeconomic Factors
Abstract
To assess the completeness of cardiac risk factor documentation by cardiologists, and agreement with patient report.
A total of 68 Ontario cardiologists and 789 of their ambulatory cardiology patients were randomly selected. Cardiac risk factor data were systematically extracted from medical charts, and a survey was mailed to participants to assess risk factor concordance.
With regard to completeness of risk factor documentation, 90.4% of charts contained a report of hypertension, 87.2% of diabetes, 80.5% of dyslipidemia, 78.6% of smoking behavior, 73.0% of other comorbidities, 48.7% of family history of heart disease, and 45.9% of body mass index or obesity. Using Cohen's k, there was a concordance of 87.7% between physician charts and patient self-report of diabetes, 69.5% for obesity, 56.8% for smoking status, 49% for hypertension, and 48.4% for family history.
Two of four major cardiac risk factors (hypertension and diabetes) were recorded in 90% of patient records; however, arguably the most important reversible risk factors for cardiac disease (dyslipidemia and smoking) were only reported 80% of the time. The results suggest that physician chart report may not be the criterion standard for quality assessment in cardiac risk factor reporting.
Notes
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PubMed ID
18411042 View in PubMed
Less detail

Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature154911
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
George Monette
Neville Suskin
Lyall Higginson
David A Alter
Donna E Stewart
Author Affiliation
York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada. sgrace@yorku.ca
Source
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):548-56
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
Male
Marital status
Middle Aged
Ontario
Outpatients - psychology
Patient Education as Topic
Patient Participation
Patient Selection
Perception
Physician's Role
Physician-Patient Relations
Prospective Studies
Questionnaires
Referral and Consultation
Abstract
Cardiac rehabilitation (CR) is an established means of reducing mortality, yet is grossly underutilized. This is due to both health system and patient-level factors; issues that have yet to be investigated concurrently. This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment.
A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist).
Cardiologists completed a survey regarding CR attitudes. Outpatients were surveyed prospectively to assess factors affecting CR enrollment. Patients were mailed a follow-up survey 9 months later to self-report CR enrollment. This was verified with 40 CR sites.
Five hundred and fifty (43.4%) outpatients were referred, and 469 (37.0%) enrolled in CR. In mixed logistic regression analyses, factors affecting verified CR enrollment were greater strength of physician endorsement (P=0.005), shorter distance to CR (P=0.001), being married (P=0.01), and fewer perceived CR barriers (P=0.03).
Both physician and patient factors play a part in CR enrollment. Patient CR barriers should be addressed during referral discussions, and reasons why physicians fail to uniformly endorse CR exploration. Although distance to CR was related to patient enrollment patterns, greater access to home-based CR services should be provided.
Notes
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PubMed ID
18830085 View in PubMed
Less detail

Contribution of patient and physician factors to cardiac rehabilitation referral: a prospective multilevel study.

https://arctichealth.org/en/permalink/ahliterature156787
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Publication Type
Article
Date
Oct-2008
Author
Sherry L Grace
Shannon Gravely-Witte
Janette Brual
Neville Suskin
Lyall Higginson
David Alter
Donna E Stewart
Author Affiliation
York University, Toronto, ON, Canada. sgrace@yorku.ca
Source
Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):653-62
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - statistics & numerical data
Attitude of Health Personnel
Comprehension
Coronary Artery Disease - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Health Services Research
Humans
Male
Middle Aged
Ontario
Outpatients - psychology - statistics & numerical data
Patient Education as Topic
Perception
Physician-Patient Relations
Physicians - psychology - statistics & numerical data
Prospective Studies
Quality of Health Care
Questionnaires
Referral and Consultation - statistics & numerical data
Abstract
Cardiac rehabilitation (CR), in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. To this end, we employed a hierarchical design to investigate physician and patient factors that affect verified CR referral.
This study was prospective with a multilevel design. We assessed 1,490 outpatients with coronary artery disease attending 97 cardiology practices. Cardiologists completed a survey about attitudes to CR referral. Outpatients were surveyed prospectively to assess sociodemographic, clinical, behavioral, psychosocial and health system factors that affected CR referral. Responses were analyzed by mixed logistic regression analyses. After 9 months, CR referral was verified at 40 centers.
Health-care providers referred 550 (43.4%) outpatients to CR. Factors affecting verified referral included positive physician perceptions of CR (P = 0.03), short distance to the closest CR site (P = 0.003), the perception of fewer barriers to CR (P
Notes
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Cites: Gen Hosp Psychiatry. 2002 May-Jun;24(3):127-3412062136
Cites: Clin Rehabil. 2002 Aug;16(5):541-5212194625
Cites: J Womens Health (Larchmt). 2002 Nov;11(9):773-9112632591
Cites: Med J Aust. 2003 Oct 6;179(7):332-314503890
Cites: J Cardiopulm Rehabil. 2003 Nov-Dec;23(6):398-40314646785
Cites: Rehabil Nurs. 2004 Jan-Feb;29(1):18-2314727472
Cites: Arch Intern Med. 2004 Jan 26;164(2):203-914744845
Cites: Am J Med. 2004 May 15;116(10):682-9215121495
Cites: Med Care. 2004 Jul;42(7):661-915213491
Cites: Can J Cardiol. 2004 Sep;20(11):1101-715457306
Cites: Res Nurs Health. 1987 Dec;10(6):357-653423307
Cites: Am J Cardiol. 1989 Sep 15;64(10):651-42782256
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Comment On: Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):671-218695694
PubMed ID
18542104 View in PubMed
Less detail

Degree and correlates of patient trust in their cardiologist.

https://arctichealth.org/en/permalink/ahliterature150338
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Publication Type
Article
Date
Aug-2009
Author
Sheena Kayaniyil
Shannon Gravely-Witte
Donna E Stewart
Lyall Higginson
Neville Suskin
David Alter
Sherry L Grace
Author Affiliation
Department of Kinesiology and Health Science, York University, Toronto, Canada.
Source
J Eval Clin Pract. 2009 Aug;15(4):634-40
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiology
Coronary Artery Disease
Female
Health Care Surveys
Humans
Male
Middle Aged
Ontario
Physician-Patient Relations
Trust
Abstract
Trust in one's doctor has been associated with increased treatment adherence, patient satisfaction and improved health status. This study investigated the level and correlates of patient trust in their cardiac specialist.
All 386 urban cardiologists in Southern Ontario (95 participating, response rate = 30%) were approached to recruit a sample of their coronary artery disease outpatients. A total of 1111 recent and consecutive patients consented to participate (approximately 13 patients per cardiologist, 317 female (26.7%); response rate = 60%), and clinical data were extracted from their medical charts. Participants completed a mailed survey including the Trust in Physicians scale, in addition to an assessment of socio-demographic, clinical and psychosocial correlates.
The mean trust score was equivalent to that reported in studies of primary care patients. Results of the significant multivariate model (F = 7.631, P
Notes
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PubMed ID
19522723 View in PubMed
Less detail

A multisite examination of sex differences in cardiac rehabilitation barriers by participation status.

https://arctichealth.org/en/permalink/ahliterature152864
Source
J Womens Health (Larchmt). 2009 Feb;18(2):209-16
Publication Type
Article
Date
Feb-2009
Author
Sherry L Grace
Shannon Gravely-Witte
Sheena Kayaniyil
Janette Brual
Neville Suskin
Donna E Stewart
Author Affiliation
York University, Ontario, Canada., University Health Network Women's Health Program, Ontario, Canada., University of Toronto, Ontario, Canada. sgrace@yorku.ca
Source
J Womens Health (Larchmt). 2009 Feb;18(2):209-16
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Cardiovascular Diseases - psychology - rehabilitation
Exercise - psychology
Female
Follow-Up Studies
Health Behavior
Health Knowledge, Attitudes, Practice
Health Services Accessibility - statistics & numerical data
Humans
Male
Ontario
Perception
Sex Distribution
Abstract
Despite its proven benefits and need, women are significantly less likely than men to participate in and complete cardiac rehabilitation (CR). The purpose of this study was to quantitatively investigate sex differences in CR barriers by participation status.
Cardiac outpatients (1496, 430 female, 28.7%) of 97 cardiologists completed a mailed survey to discern CR participation. Respondents were asked to rate 19 CR barriers on a 5-point Likert scale.
Five hundred twenty-nine (43%) respondents self-reported participating in CR, with men being more likely to participate (p
Notes
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PubMed ID
19183092 View in PubMed
Less detail

Quality of life following participation in cardiac rehabilitation programs of longer or shorter than 6 months: does duration matter?

https://arctichealth.org/en/permalink/ahliterature137858
Source
Popul Health Manag. 2011 Aug;14(4):181-8
Publication Type
Article
Date
Aug-2011
Author
Yvonne W Leung
Keerat Grewal
Shannon Gravely-Witte
Neville Suskin
Donna E Stewart
Sherry L Grace
Author Affiliation
Kinesiology & Health Science, York University, Toronto, Ontario, Canada.
Source
Popul Health Manag. 2011 Aug;14(4):181-8
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - rehabilitation
Female
Humans
Male
Middle Aged
Ontario
Outcome Assessment (Health Care)
Program Evaluation
Prospective Studies
Quality of Life
Questionnaires
Secondary Prevention - organization & administration
Time Factors
Abstract
Cardiac rehabilitation (CR) participation results in significant health benefits. However, there is wide variation in program duration, and little is known about the optimal duration of CR for patient outcomes. The objective of this study was to compare quality of life (QoL) of patients who participated in CR programs of??0.0001), and PTGI (P?=?0.007) were significantly greater regardless of CR duration when compared to those who did not attend CR. There were no significant differences in outcomes when comparing patients attending CR programs of?
PubMed ID
21241185 View in PubMed
Less detail

A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients.

https://arctichealth.org/en/permalink/ahliterature137552
Source
Anxiety Stress Coping. 2011 Jul;24(4):463-75
Publication Type
Article
Date
Jul-2011
Author
Keerat Grewal
Shannon Gravely-Witte
Donna E Stewart
Sherry L Grace
Author Affiliation
Faculty of Health, Kinesiology & Health Science, York University, Toronto, Ontario, Canada.
Source
Anxiety Stress Coping. 2011 Jul;24(4):463-75
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Aged
Angina Pectoris - psychology - rehabilitation
Anxiety Disorders - diagnosis - psychology
Coronary Artery Disease - psychology - rehabilitation
Depressive Disorder - diagnosis - psychology
Female
Hostility
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction - psychology - rehabilitation
Myocardial Revascularization - psychology
Ontario
Patient Readmission
Personality Inventory - statistics & numerical data
Prognosis
Psychometrics - statistics & numerical data
Recurrence
Reproducibility of Results
Risk factors
Social Support
Stress, Psychological - complications
Abstract
Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores and recurrent events in CAD patients. There were 1268 CAD outpatients of 97 cardiologists surveyed at two points. Recurrent events or hospitalization in the intervening nine months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support, and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and to investigate treatments are needed.
PubMed ID
21271407 View in PubMed
Less detail

7 records – page 1 of 1.