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dc.contributor.authorSérvio, Thaianne Cavalcante
dc.contributor.authorBritto, Raquel
dc.contributor.authorLima de Melo Ghisi, Gabriela
dc.contributor.authorda Silva, Lilian Pinto
dc.contributor.authorDuarte Novais Silva, Luciana
dc.contributor.authorLima, Márcia Maria Oliveira
dc.contributor.authorPereira, Danielle Aparecida Gomes
dc.contributor.authorGrace, Sherry L.
dc.identifier.citationBMC Health Services Research 19 (2019): 615.en_US
dc.description.abstractBackground: Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its’ worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a lowresource setting. Methods: In this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale. Results: Thirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01). Conclusions: The inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed. Keywords: Health care services, Cardiac rehabilitation, Cardiac care facilities, Attitude of health personnelen_US
dc.description.sponsorshipYork University Librariesen_US
dc.publisherBiomed Centralen_US
dc.rightsAttribution 2.5 Canada*
dc.subjectHealth care servicesen_US
dc.subjectCardiac rehabilitationen_US
dc.subjectCardiac care facilitiesen_US
dc.subjectAttitude of health personnelen_US
dc.titleBarriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers, and cardiac patientsen_US

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Attribution 2.5 Canada
Except where otherwise noted, this item's license is described as Attribution 2.5 Canada