title: Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A prospective multisite study, using a multilevel design of 1490 coronary artery disease outpatients nested within 97 Ontario cardiology practices (mean 15 per cardiologist).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada. sgrace@yorku.ca
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely-Witte
authors.forename: Janette
authors.initials: J
authors.lastname: Brual
authors.forename: George
authors.initials: G
authors.lastname: Monette
authors.forename: Neville
authors.initials: N
authors.lastname: Suskin
authors.forename: Lyall
authors.initials: L
authors.lastname: Higginson
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009864:Ontario; D010045:Outpatients / Q000523:psychology; D010353:Patient Education as Topic; D010358:Patient Participation; D018579:Patient Selection; D010465:Perception; D010819:Physician's Role; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires