title: A prospective examination of disease management program use by complex cardiac outpatients.
abstract: BACKGROUND
  The use of disease management programs (DMPs) by patients with cardiovascular disease (CVD) is associated with improved outcomes. Although rates of cardiac rehabilitation (CR) use are well established, less is known about other DMPs. The objectives of this study were to describe the degree of DMP utilization by CVD outpatients, and examine factors related to use.
  
  
  METHODS
  This study represents a secondary analysis of a larger prospective cohort study. In hospital, 2635 CVD inpatients from 11 hospitals in Ontario Canada completed a survey that assessed factors affecting DMP utilization. One year later, 1803 participants completed a mailed survey that assessed DMP utilization.
  
  
  RESULTS
  One thousand seventy-three (59.5%) participants reported using at least 1 DMP. Overall, 951 (52.7%) reported participating in cardiac rehabilitation, and among participants with a comorbid indication, 212 (41.2%) reported attending a diabetes education centre, 28 (25.9%) attended stroke rehabilitation, 35 (12.9%) used a heart failure clinic, and 13 (11.7%) attended a smoking cessation program. A multinomial logistic regression analysis showed that compared with no DMP use, participants that attended 1 or multiple programs were younger, married, diagnosed with a myocardial infarction, less likely to have had a percutaneous coronary intervention and had higher perceptions of personal control over their heart condition. There were few differences between participants that used 1 vs multiple DMPs, however, having diabetes or comorbid stroke significantly increased the likelihood of multiple DMP use.
  
  
  CONCLUSIONS
  Approximately 40% of CVD outpatients do not access DMPs. An integrated approach to vascular disease management appears warranted.
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015906:Angioplasty, Balloon, Coronary / Q000534:rehabilitation*; D058385:Cardiac Valve Annuloplasty / Q000534:rehabilitation*; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D003327:Coronary Disease / Q000453:epidemiology* / Q000534:rehabilitation*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000534:rehabilitation*; D019918:Heart Valve Prosthesis Implantation / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome