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Access to cardiac rehabilitation among South-Asian patients by referral method: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature143716
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Publication Type
Article
Author
Keerat Grewal
Yvonne W Leung
Parissa Safai
Donna E Stewart
Sonia Anand
Milan Gupta
Cynthia Parsons
Sherry L Grace
Author Affiliation
University of Toronto, ON. keerat.grewal@utoronto.ca
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - ethnology - rehabilitation
Asia, Western - ethnology
Asian Continental Ancestry Group
Automation
Continuity of Patient Care
Emigrants and Immigrants
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
India - ethnology
Male
Middle Aged
Ontario
Referral and Consultation
Abstract
People of South-Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South-Asian patients. Participants were South-Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one offour methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive-descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants'needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient-provider communication.
PubMed ID
20450019 View in PubMed
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A comparison of physical activity environments between South Asians and white Caucasians with coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature137210
Source
Ethn Dis. 2010;20(4):390-5
Publication Type
Article
Date
2010
Author
Shazareen N Khan
Sherry L Grace
Paul Oh
Sonia Anand
Donna E Stewart
Gilbert Wu
Milan Gupta
Author Affiliation
University of Toronto, Ontario, Canada.
Source
Ethn Dis. 2010;20(4):390-5
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Asia, Southeastern - ethnology
Coronary disease - ethnology
Female
Humans
Male
Middle Aged
Motor Activity
Multivariate Analysis
Ontario - epidemiology
Abstract
South Asians (SA) are predisposed to developing premature coronary heart disease (CHD), partly due to the early onset of classic risk factors, including physical inactivity. The nature of physical activity (PA) environments in South Asians in Canada remains unknown. Our objective was to examine differences in PA environments for South Asian vs White Caucasian (WC) CHD patients. In a cross-sectional study, 2657 hospitalized CHD patients in Ontario completed The Perceived Environments Related to Physical Activity Questionnaire to assess their home and neighborhood environment, perceived neighborhood safety and availability of recreational facilities. Patients self-reporting their ethnocultural background as WC (N = 1301, 48.6%) or SA (N = 171, 6.4%) were included in this study. South Asians were significantly younger, had lower body mass index, higher levels of education, lower income, were less likely to smoke and reside rurally, and were more likely to be married, have diabetes mellitus and have experienced prior myocardial infarction (MI) than WC patients. South Asians also had lower availability of home exercise equipment and perceived convenience of local PA facilities, but better and safer neighborhood environments than WC patients. Multivariate analyses revealed that SA ethnocultural background remained significantly related to reduced availability of home exercise equipment and fewer convenient local PA facilities. Since physical inactivity is an important CHD risk factor, and SA ethnocultural background is associated with high CHD risk, this may represent a novel target for risk reduction. Thus, further research is required to optimize SA awareness of the need for PA, and access to equipment and facilities.
Notes
SummaryForPatientsIn: Ethn Dis. 2010 Autumn;20(4):48821305843
PubMed ID
21305827 View in PubMed
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Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study.

https://arctichealth.org/en/permalink/ahliterature118174
Source
Implement Sci. 2012;7:120
Publication Type
Article
Date
2012
Author
Sherry L Grace
Kelly L Angevaare
Robert D Reid
Paul Oh
Sonia Anand
Milan Gupta
Stephanie Brister
Donna E Stewart
Author Affiliation
School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Canada. sgrace@yorku.ca
Source
Implement Sci. 2012;7:120
Date
2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Appointments and Schedules
Coronary Artery Bypass - rehabilitation
Humans
Inpatients
Middle Aged
Ontario
Outpatients
Patient Care Management - organization & administration
Patient Education as Topic - organization & administration
Percutaneous Coronary Intervention - rehabilitation
Prospective Studies
Referral and Consultation - organization & administration
Sex Factors
Socioeconomic Factors
Abstract
Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants' CR referral and enrollment was examined using generalized estimating equations.
A total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95).
These readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.
Notes
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PubMed ID
23234558 View in PubMed
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Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study.

https://arctichealth.org/en/permalink/ahliterature136984
Source
Arch Intern Med. 2011 Feb 14;171(3):235-41
Publication Type
Article
Date
Feb-14-2011
Author
Sherry L Grace
Kelly L Russell
Robert D Reid
Paul Oh
Sonia Anand
James Rush
Karen Williamson
Milan Gupta
David A Alter
Donna E Stewart
Author Affiliation
School of Kinesiology and Health Sciences, Faculty of Health, York University, 368 Bethune, 4700 Keele St, Toronto, ON M3J 1P3, Canada. sgrace@yorku.ca
Source
Arch Intern Med. 2011 Feb 14;171(3):235-41
Date
Feb-14-2011
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - rehabilitation
Aged
Angioplasty, Balloon, Coronary - rehabilitation
Cooperative Behavior
Female
Health Services Accessibility - statistics & numerical data
Humans
Interdisciplinary Communication
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Odds Ratio
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Patient care team
Patient Discharge - statistics & numerical data
Pilot Projects
Prospective Studies
Referral and Consultation - utilization
Rehabilitation Centers - utilization
Telephone
Utilization Review - statistics & numerical data
Abstract
Although cardiac rehabilitation (CR) has been shown to reduce mortality and is a recommended component in clinical practice guidelines, CR referral and utilization rates remain low. Referral strategies have been implemented to increase CR use but have yet to be compared concurrently. To determine the optimal strategy to maximize CR referral, enrollment, and participation, we evaluated 3 referral strategies compared with usual care: "automatic" only via discharge order or electronic record, health care provider liaison only, or a combined approach.
In this prospective controlled study, 2635 inpatients with coronary artery disease from 11 Ontario, Canada, hospitals using 1 of the 4 referral strategies completed a sociodemographic survey, and clinical data were extracted from medical charts. One year later, 1809 participants completed a mailed survey that assessed CR utilization. Referral strategies were compared using generalized estimating equations to control for effect of hospital.
Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment (P
PubMed ID
21325114 View in PubMed
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