title: Variation in patient perceptions of healthcare provider endorsement of cardiac rehabilitation.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) is significantly underutilized. However, physician endorsement promotes greater patient utilization. This study examined perceptions of provider endorsement by patients (1) of sociodemographic groups who are often less represented in CR and by clinical indication and (2) by type of healthcare provider and place of referral.
  
  
  METHODS
  Referred cardiac (N = 1156) inpatients from 11 hospitals across Ontario completed a sociodemographic survey inhospital and a mailed followup survey 1 year later. Respondents self-reported perceived healthcare provider endorsement of CR on a 5-point Likert scale, type of referring healthcare provider, and where the referral was initiated.
  
  
  RESULTS
  The overall perceived strength of healthcare provider endorsement to CR was 3.75 ± 1.15. Patients who perceived greater endorsement were significantly more likely to enrol (OR = 2.07) and attend a greater percentage of CR sessions (P < .001). Student t tests showed that women (P < .01), those older than 65 years (P < .01), with lower annual family income (P < .001), less than high school education (P < .01), who were retired (P < .01), or had lower subjective social status (P < .01) reported significantly lower perceived healthcare provider endorsement of CR than their respective counterparts. Perception of CR endorsement did not differ significantly on the basis of location of referral initiation (P ≥ .05), but those who discussed CR with family doctors (P < .05), cardiologists (P < .05), or cardiac surgeons (P < .01) reported significantly greater endorsement than those discussing CR with nurses.
  
  
  CONCLUSIONS
  Given the proven benefits of CR, all healthcare providers are recommended to universally and strongly encourage CR participation among their patients in order to optimize utilization and subsequent recovery.
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Courtney Kwan-Yee
authors.initials: CK
authors.lastname: Tsui
authors.forename: Shamila
authors.initials: S
authors.lastname: Shanmugasegaram
authors.forename: Veronica
authors.initials: V
authors.lastname: Jamnik
authors.forename: Gilbert
authors.initials: G
authors.lastname: Wu
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010465:Perception; D010817:Physician-Patient Relations; D011594:Psychometrics; D012017:Referral and Consultation; D012923:Social Class; D013223:Statistics as Topic