title: Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR).
  
  
  METHODS
  Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined.
  
  
  RESULTS
  Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, p<0.0001) and PR increased by 32.8% to reach 26%. Personal endorsement of CRBI by cardiologists known to patients increased CR program graduation rate by 35%.
  
  
  CONCLUSIONS
  Cardiologists' awareness of CRBI increases CR RR and their personal endorsement improves PR and compliance. Education of providers and implementation of a formal referral system can improve RR and PR.
authors: University of Iowa, Iowa City, IA, USA.
authors: Ali
authors: A
authors: Dahhan
authors: Georgia Regents University, Augusta, GA, USA.
authors: William R
authors: WR
authors: Maddox
authors: University of Iowa, Iowa City, IA, USA.
authors: Siva
authors: S
authors: Krothapalli
authors: Georgia Regents University, Augusta, GA, USA.
authors: Matthew
authors: M
authors: Farmer
authors: Georgia Regents University, Augusta, GA, USA.
authors: Amit
authors: A
authors: Shah
authors: Georgia Regents University, Augusta, GA, USA.
authors: Benjamin
authors: B
authors: Ford
authors: Georgia Regents University, Augusta, GA, USA.
authors: Marc
authors: M
authors: Rhodes
authors: Georgia Regents University, Augusta, GA, USA.
authors: Laurie
authors: L
authors: Matthews
authors: Georgia Prevention Center, Augusta, GA, USA.
authors: Vernon A
authors: VA
authors: Barnes
authors: Georgia Regents University, Augusta, GA, USA. Electronic address: GSharma@gru.edu.
authors: Gyanendra K
authors: GK
authors: Sharma
mesh_terms: D000368:Aged; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000193:education* / Q000379:methods / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D063128:Tertiary Health Care
keywords: Cardiac rehabilitation; Education; Percutaneous coronary intervention; Prevention; Referral.