title: Cardiac Rehabilitation: Unraveling the Complexity of Referral and Current Models of Delivery.
abstract: BACKGROUND
  Evidence-based guidelines recommend strategies for reducing risk factors for secondary prevention of acute coronary syndromes, yet referral to and completion of programs to deliver this advice are poor.
  
  
  OBJECTIVE
  In this article we describe the complexity of factors that influence referral and delivery of evidence-based cardiac rehabilitation (CR) programs through an Australian context and provide direction for solutions for clinicians and policy makers to consider. The Ecological Approach is used as a framework to synthesize evidence. The approach has 5 categories, the characteristics of which may act as barriers and enablers to the promotion and adoption of health behaviors and includes (a) interpersonal factors, (b) interpersonal factors, (c) institutional factors, (d) community networks, and (e) public policy.
  
  
  CONCLUSIONS
  Despite the context of strong evidence for efficacy, this review highlights systematic flaws in the implementation of CR, an important intervention that has been shown to improve patient outcomes and prevent cardiac events. Recommendations from this review include standardization of program delivery, improvement of data capture, use of technological innovations and social networks to facilitate delivery of information and support, and establishment of a cohesive, consistent message through interorganizational collaboration involved in CR.
  
  
  CONCLUSIONS
  These avenues provide direction for potential solutions to improve the uptake of CR and secondary prevention.
authors.affiliation: Carolyn M. Astley, RN, DrPH Senior Lecturer, School of Medicine, Faculty Health Sciences, Flinders University, South Australia, Australia. Lis Neubeck, PhD, RN Senior Lecturer, Charles Perkins Centre Sydney Nursing School, University Sydney, New South Wales, Australia. Robyn Gallagher, PhD, RN Professor of Nursing, Charles Perkins Centre Sydney Nursing School, University Sydney, New South Wales, Australia. Narelle Berry, PhD Research Fellow, School of Nursing & Midwifery, Faculty Health Sciences, Flinders University, South Australia, Australia. Huiyun Du, PhD, RN Lecturer in Nursing, School of Nursing & Midwifery, Faculty Health Sciences, Flinders University, South Australia, Australia. Martha N. Hill, PhD, RN Emeritus Dean, Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland. Robyn A. Clark, PhD, RN Professor, Acute Cardiac Care and Cardiovascular Research, School of Nursing & Midwifery, Faculty Health Sciences, Flinders University, South Australia, Australia.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Astley
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
authors.forename: Narelle
authors.initials: N
authors.lastname: Berry
authors.forename: Huiyun
authors.initials: H
authors.lastname: Du
authors.forename: Martha N
authors.initials: MN
authors.lastname: Hill
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D001315:Australia; D000072038:Cardiac Rehabilitation; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D012017:Referral and Consultation / Q000458:organization & administration*; D055502:Secondary Prevention / Q000458:organization & administration*