The Role of Systematic Inpatient Cardiac Rehabilitation Referral In Increasing Equitable Access and Utilization
Grace, Sherry L.
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Background: While systematic referral strategies have been shown to significantly increase cardiac rehabilitation (CR) enrolment to approximately 70%, whether utilization rates increase among patient groups who are traditionally under-represented has yet to be established. This study compared CR utilization based on age, marital status, rurality, socioeconomic indicators, clinical risk, and comorbidities following systematic versus non-systematic CR referral. Methods: 2635 coronary artery disease inpatients from 11 Ontario hospitals utilizing either systematic (n=8 wards) or non-systematic referral strategies (n=8 wards) completed a survey including sociodemographics and activity status. Clinical data were extracted from charts. At one-year, 1680 participants completed a mailed survey that assessed CR utilization. The association of patient characteristics and referral strategy on CR utilization was tested using chi-square. Results: When compared to non-systematic referral, systematic strategies resulted in significantly greater CR referral and enrolment among obese (32 vs 27% referred, p=.044; 33 vs 26% enrolled, p = .047) patients of lower socioeconomic status (41 vs 34% referred, p=0.26; 42 vs 32% enrolled, p=.005) and lower activity status (63 vs 54% referred, p=.005; 62 vs 51% enrolled, p=.002). There was significantly greater enrolment among those of lower education (p=.04) when systematically referred, however no significant differences in degree of CR participation based on referral strategy. Conclusion: Up to 11% more socioeconomically-disadvantaged patients and those with more risk factors utilized CR where systematic processes were in place. They participated in CR to the same high degree as their non-systematically referred counterparts. These referral strategies should be implemented to promote equitable access.