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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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Ambulatory surveillance of patients referred for cardiac rehabilitation following cardiac hospitalization: a feasibility study.

https://arctichealth.org/en/permalink/ahliterature125434
Source
Can J Cardiol. 2012 Jul-Aug;28(4):497-501
Publication Type
Article
Author
David A Alter
Juda Habot
Sherry L Grace
Terry Fair
David Kiernan
Wendy Clark
David Fell
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. david.alter@ices.on.ca
Source
Can J Cardiol. 2012 Jul-Aug;28(4):497-501
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - rehabilitation
Adult
Aged
Aged, 80 and over
Ambulatory Care
Angioplasty, Balloon, Coronary - mortality - rehabilitation
Coronary Artery Bypass - mortality - rehabilitation
Feasibility Studies
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation - mortality - rehabilitation
Hospitalization
Hospitals, Community
Humans
Male
Middle Aged
Myocardial Infarction - mortality - rehabilitation
Ontario
Patient Readmission - statistics & numerical data
Population Surveillance - methods
Referral and Consultation
Survival Analysis
Waiting Lists
Abstract
Our purpose was to examine the feasibility of implementing an ambulatory surveillance system for monitoring patients referred to cardiac rehabilitation following cardiac hospitalizations.
This study consists of 1208 consecutive referrals to cardiac rehabilitation between October 2007 and April 2008. Patient attendance at cardiac rehabilitation, waiting times for cardiac rehabilitation, and adverse events while waiting for cardiac rehabilitation were tracked by telephone surveillance by a nurse.
Among the 1208 consecutive patients referred, only 44.7% attended cardiac rehabilitation; 36.4% of referred patients were known not to have attended any cardiac rehabilitation, while an additional 18.9% of referred patients were lost to follow-up. Among the 456 referred patients who attended the cardiac rehabilitation program, 19 (4.2%) experienced an adverse event while in the queue (13 of which were for cardiovascular hospitalizations with no deaths), with mean waiting times of 20 days and 24 days among those without and with adverse events, respectively. Among the 440 referred patients who were known not to have attended any cardiac rehabilitation program, 114 (25.9%) had adverse clinical events while in the queue; 46 of these events required cardiac hospitalization and 8 patients died.
Ambulatory surveillance for cardiac rehabilitation referrals is feasible. The high adverse event rates in the queue, particularly among patients who are referred but who do not attend cardiac rehabilitation programs, underscores the importance of ambulatory referral surveillance systems for cardiac rehabilitation following cardiac hospitalizations.
PubMed ID
22480901 View in PubMed
Less detail

Automatic referral to cardiac rehabilitation.

https://arctichealth.org/en/permalink/ahliterature179514
Source
Med Care. 2004 Jul;42(7):661-9
Publication Type
Article
Date
Jul-2004
Author
Sherry L Grace
Alexandra Evindar
Tabitha N Kung
Patricia E Scholey
Donna E Stewart
Author Affiliation
University Health Network Women's Health Program, Toronto, Ontario, Canada. sherry.grace@uhn.on.ca
Source
Med Care. 2004 Jul;42(7):661-9
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Aged
Arteriosclerosis - rehabilitation
Causality
Cross-Sectional Studies
Factor Analysis, Statistical
Female
Humans
Logistic Models
Male
Middle Aged
Models, Psychological
Ontario
Patient Acceptance of Health Care - psychology
Referral and Consultation
Socioeconomic Factors
Abstract
Cardiac rehabilitation (CR) remains underused and inconsistently accessed, particularly for women and minorities. This study examined the factors associated with CR enrollment within the context of an automatic referral system through a retrospective chart review plus survey. Through the Behavioral Model of Health Services Utilization, it was postulated that enabling and perceived need factors, but not predisposing factors, would significantly predict patient enrollment.
A random sample of all atherosclerotic heart disease (AHD) patients treated at a tertiary care center (Trillium Health Centre, Ontario, Canada) from April 2001 to May 2002 (n = 501) were mailed a survey using a modified Dillman method (71% response rate).
Predisposing measures consisted of sociodemographics such as age, sex, ethnocultural background, work status, level of education, and income. Enabling factors consisted of barriers and facilitators to CR attendance, exercise benefits and barriers (EBBS), and social support (MOS). Perceived need factors consisted of illness perceptions (IPQ) and body mass index.
Of the 272 participants, 199 (73.2%) attended a CR assessment. Lower denial/minimization, fewer logistical barriers to CR (eg, distance, cost), and lower perceptions of AHD as cyclical or episodic reliably predicted CR enrollment among cardiac patients who were automatically referred.
Because none of the predisposing factors were significant in the final model, this suggests that factors associated with CR enrollment within the context of an automatic referral model relate to enabling factors and perceived need. A prospective controlled evaluation of automatic referral is warranted.
PubMed ID
15213491 View in PubMed
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Cardiac rehabilitation barriers by rurality and socioeconomic status: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature107685
Source
Int J Equity Health. 2013;12:72
Publication Type
Article
Date
2013
Author
Shamila Shanmugasegaram
Paul Oh
Robert D Reid
Treva McCumber
Sherry L Grace
Author Affiliation
York University and University Health Network, Toronto, Canada. sgrace@yorku.ca.
Source
Int J Equity Health. 2013;12:72
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Female
Health Services Accessibility - standards - statistics & numerical data
Heart Diseases - rehabilitation
Humans
Male
Middle Aged
Ontario
Rural Population - statistics & numerical data
Socioeconomic Factors
Abstract
Despite greater need, rural inhabitants and individuals of low socioeconomic status (SES) are less likely to undertake cardiac rehabilitation (CR). This study examined barriers to enrollment and participation in CR among these under-represented groups.
Cardiac inpatients from 11 hospitals across Ontario were approached to participate in a larger study. Rurality was assessed by asking participants whether they lived within a 30-minute drive-time from the nearest hospital, with those >30 minutes considered "rural." Participants completed a sociodemographic survey, which included the MacArthur Scale of Subjective Social Status. One year later, they were mailed a survey which assessed CR utilization and included the Cardiac Rehabilitation Barriers Scale. In this cross-sectional study, CR utilization and barriers were compared by rurality and SES.
Of the 1809 (80.4%) retained, there were 215 (11.9%) rural participants, and the mean subjective SES was 6.37 ± 1.76. The mean CRBS score was 2.03 ± 0.73. Rural inhabitants reported attending significantly fewer CR sessions (p
Notes
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PubMed ID
23985017 View in PubMed
Less detail

Cardiac rehabilitation wait times: effect on enrollment.

https://arctichealth.org/en/permalink/ahliterature132353
Source
J Cardiopulm Rehabil Prev. 2011 Nov-Dec;31(6):373-7
Publication Type
Article
Author
Kelly L Russell
Tanya M Holloway
Margaret Brum
Veola Caruso
Caroline Chessex
Sherry L Grace
Author Affiliation
University Health Network, Toronto, Ontario, Canada.
Source
J Cardiopulm Rehabil Prev. 2011 Nov-Dec;31(6):373-7
Language
English
Publication Type
Article
Keywords
Canada
Coronary Disease - rehabilitation
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Patient Compliance - statistics & numerical data
Questionnaires
Referral and Consultation
Retrospective Studies
Time Factors
Waiting Lists
Abstract
Cardiac rehabilitation (CR) is a proven effective means for secondary prevention of coronary heart disease. Timely access to CR services is key to promoting patient participation and ensuring optimal patient outcomes. Despite wait time benchmarks having been established, research regarding how long patients wait to enter CR following referral receipt is limited. The aim of this study was to (a) describe wait times from CR referral to intake assessment and (b) examine the association of wait time to CR enrollment rates.
Wait time from date of CR referral to date of intake assessment was calculated in days for 599 participants referred to CR from 2006 to 2009 inclusive. A descriptive examination of sociodemographic and clinical characteristics was performed, followed by logistic regression analysis to assess the wait time by enrollment relationship.
Median wait time from referral receipt to CR intake was 42.0 days. Wait time had a negative effect on CR enrollment, such that for every 1-day increment in wait time, patients were 1% less likely to enroll.
The time that patients wait to enroll in CR may affect the number of patients who choose to attend, and longer wait times may mean fewer patients will benefit from CR participation. Programs should be encouraged to undertake quality improvement initiatives to ensure wait times are not negatively impacting patient enrollment and ultimately preventing patients from benefiting from CR participation. Further research is needed to establish evidence-based wait time benchmarks and interventions to promote timely access to CR services.
PubMed ID
21826016 View in PubMed
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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
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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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Continuity of cardiac care: cardiac rehabilitation participation and other correlates.

https://arctichealth.org/en/permalink/ahliterature165450
Source
Int J Cardiol. 2007 Jul 31;119(3):326-33
Publication Type
Article
Date
Jul-31-2007
Author
Dana L Riley
Donna E Stewart
Sherry L Grace
Author Affiliation
York University, Canada.
Source
Int J Cardiol. 2007 Jul 31;119(3):326-33
Date
Jul-31-2007
Language
English
Publication Type
Article
Keywords
Aged
Angina Pectoris - rehabilitation
Continuity of Patient Care - organization & administration
Female
Health Care Surveys
Humans
Interdisciplinary Communication
Male
Middle Aged
Myocardial Infarction - rehabilitation
Ontario
Patient satisfaction
Syndrome
Universal Coverage
Abstract
Continuity of care refers to the ongoing management of a patient's care over time and across practitioners, and the patient's experience of this care as coherent and consistent with their medical needs and context. Continuity of cardiac care is integral to secondary prevention and improved health outcomes.
This study examined patient perceptions of continuity, and how they relate to cardiac rehabilitation participation and other correlates.
Consecutive acute coronary syndrome patients at 3 hospitals were approached, and 661 consented to complete a survey (504 men, 157 women; 75% response rate). Nine months later, 506 participants completed a survey including the Heart Continuity of Care Questionnaire, open-ended continuity perceptions, and self-reported cardiac rehabilitation participation (yes/no).
The mean continuity perceptions were highly positive, and were equivalent to those found in another Canadian province, although open-ended responses revealed discontinuity with regard to outpatient visits and pharmacotherapy prescriptions. In a multivariate model (p=.003), the correlates of greater perceptions of continuity of cardiac care 9 months post-discharge were cardiac rehabilitation participation (p
Notes
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PubMed ID
17258332 View in PubMed
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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
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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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Comment On: Nat Clin Pract Cardiovasc Med. 2008 Oct;5(10):671-218695694
PubMed ID
18542104 View in PubMed
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