Utilisation of outpatient cardiac rehabilitation in Queensland.
OBJECTIVE
To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs.


METHODS
Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs.


METHODS
Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private).


METHODS
Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance.


RESULTS
15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality.


CONCLUSIONS
There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.
D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D015906:Angioplasty, Balloon, Coronary / Q000534:rehabilitation*; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000534:rehabilitation*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011793:Queensland; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies