Five-year changes in North Carolina outpatient cardiac rehabilitation.
OBJECTIVE
The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier.


METHODS
In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004.


RESULTS
More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004.


CONCLUSIONS
Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.
Evenson
Kelly R
KR
Department of Epidemiology, School of Public Health, University of North Carolina-Chapel Hill, NC 27514, USA. kelly_evenson@unc.edu
Johnson
Anna
A
Aytur
Semra A
SA
D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000534:rehabilitation*; D009657:North Carolina; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data