Validation of the Physician Attitudes toward Cardiac Rehabilitation & Referral (PACRR) Scale
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Background: One of the key drivers of cardiac rehabilitation under-utilization is physician referral failure. The Physician Attitudes toward Cardiac Rehabilitation & Referral (PACRR) scale was developed to understand factors that impact their referral practices, so they can be ultimately reliably be identified and mitigated. The objectives of this study were to assess the reliability, factor structure, and validity of the PACRR. Methods: Data were retrospectively analyzed from 3 cohorts administering the PACRR, a 19-item scale. The first cohort consisted of 185 cardiologists or family physicians; the second of 51 of the same, and the third of 97 cardiologists. Internal consistency was assessed by Cronbach's alpha, factor structure by confirmatory factor analysis, construct validity by significant differences in PACRR scores by physician specialty, and criterion validity by testing for significant differences in PACRR scores by referral. Results: Cronbach’s alpha was 0.81, 0.71, and 0.69 in each of the 3 cohorts, respectively. Factor analysis in the latter 2 cohorts revealed 4 factors: referral norms, preference to manage patients independently of CR, perceptions of program quality, and referral processes. Construct validity was established in the first cohort, as significant differences in PACRR scores were found by physician specialty. Criterion validity was supported by significant differences in mean scores by referral in each cohort. Physicians rated bad experiences with CR programs, poor program quality, skepticism of CR benefits and lack of familiarity with local programs as the most important factors that affected their referral to CR. Conclusions: In conclusion, the PACRR scale was demonstrated to have good reliability and validity. Physician Attitudes toward Cardiac Rehabilitation & Referral.
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