title: Perceptions of cardiac specialists and rehabilitation programs regarding patient access to cardiac rehabilitation and referral strategies.
abstract: BACKGROUND
  Access to cardiac rehabilitation (CR) remains at approximately 30%, despite a national target of 70%. This study evaluated cardiac specialist and CR program perceptions of CR access and referral strategies.
  
  
  METHODS
  Postal and online surveys of Canadian CR specialists and CR programs were administered. Responses were received from 71 of 765 CR specialists (9.3%) and 92 of 149 CR programs (61.7%). Respondents rated perceptions on 5-point Likert scales.
  
  
  RESULTS
  Specialists rated patient access to CR as moderate (2.9 ± 1.4). While they reported that they refer 65.9% of their patients, they most frequently do not refer because their patients report disinterest (23.4%) or geographic barriers to access (23.4%). Cardiac rehabilitation programs reported having capacity to serve a median of 275 patients annually, yet reportedly serving up to 350. The most commonly used methods of referral included discharge order sets (over 60%) and allied health care provider support. Electronic referral was perceived to be highly effective (4.1 ± 1.0) yet the least frequently used. Cardiac rehabilitation programs perceived more patients are accessing CR because of these referral strategies, but increased patients strain program resources.
  
  
  CONCLUSIONS
  Some of the least frequently used referral strategies were perceived as, and are also empirically demonstrated to be, most effective. Broader implementation of these strategies, while better-resourcing CR programs, may improve the continuum of care for cardiac patients.
authors.affiliation: University Health Network, Toronto, Ontario, Canada. sgrace@yorku.ca
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Yongyao
authors.initials: Y
authors.lastname: Tan
authors.forename: Chris
authors.initials: C
authors.lastname: Simpson
authors.forename: Caroline
authors.initials: C
authors.lastname: Chessex
mesh_terms: D000072038:Cardiac Rehabilitation; D002983:Clinical Competence; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D009864:Ontario; D017410:Practice Guidelines as Topic; D011792:Quebec; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires