Factors Associated With Utilization of Cardiac Rehabilitation Among Patients With Ischemic Heart Disease in the Veterans Health Administration: A QUALITATIVE STUDY.
BACKGROUND
Cardiac rehabilitation (CR) programs reduce morbidity and mortality in patients with ischemic heart disease but are vastly underutilized in the United States, including the Veterans Health Administration (VA) Healthcare System. Numerous barriers affecting utilization have been identified in other health care systems, but the specific factors affecting Veterans are unknown. We sought to identify barriers and facilitators associated with utilization of CR in VA facilities.


METHODS
We performed a qualitative study of 56 VA patients, providers, and CR program managers at 30 VA facilities across the United States. We conducted semistructured interviews with key informants to explore their attitudes and knowledge toward CR. Interviews were conducted until thematic saturation occurred. Analyses using grounded theory to identify key themes were conducted using the qualitative data analysis package ATLAS.ti.


RESULTS
We identified 6 themes as barriers and 5 as facilitators. The most common barriers to participation in CR were patient transportation issues (68%), lack of patient willingness to participate (41%), and no access to a nearby VA hospital with a CR program (30%). The most common facilitators were involvement of a dedicated provider or "clinical champion" (50%), provider knowledge of or experience with CR (48%), and patient desire for additional medical support (32%).


CONCLUSIONS
Our findings suggest that addressing access issues and educating and activating providers on CR may increase utilization of CR programs. Targeting these specific factors may improve utilization of CR programs.
Department of Medicine (Drs Schopfer and Whooley), San Francisco Veterans Affairs Medical Center, San Francisco, California; Department of Medicine (Drs Schopfer and Whooley), University of California, San Francisco, California; School of Nursing (Ms Priano), University of California, San Francisco, California; Geriatric Research, Education, and Clinical Center (Ms Allsup and Dr Forman), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Northwest Health Services Research and Development Center of Excellence (Dr Helfrich), Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Division of Cardiology (Drs Ho and Rumsfeld), Denver Veterans Affairs Medical Center, Denver, Colorado; Department of Medicine (Drs Ho and Rumsfeld), Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colorado; Geriatric Cardiology Section (Dr Forman), University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Medicine (Dr Forman), University of Pittsburgh, Pittsburgh, PA; Department Epidemiology and Biostatistics (Dr Whooley), University of California, San Francisco, California.
David W
DW
Schopfer
Susan
S
Priano
Kelly
K
Allsup
Christian D
CD
Helfrich
P Michael
PM
Ho
John S
JS
Rumsfeld
Daniel E
DE
Forman
Mary A
MA
Whooley
D001291:Attitude of Health Personnel; D000072038:Cardiac Rehabilitation / Q000706:statistics & numerical data*; D002983:Clinical Competence; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D017202:Myocardial Ischemia / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D014186:Transportation; D014481:United States; D014493:United States Department of Veterans Affairs