A survey of the perceptions of barriers to and facilitators of cardiac rehabilitation in healthcare providers and policy stakeholders

Abstract

Background Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea. Methods We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed. Results Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations. Conclusions Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects.

Fact Sheet on Cardiac Rehabilitation for Cardiovascular Disease in South Korea

“…Furthermore, the self-reliant attitudes common in rural areas, combined with limited access to medical facilities, may lead to lower CR participation among rural residents. The inability of patients to accurately recognize the need for and the importance of CR, along with issues of accessibility, cost, and time constraints, also contribute to the low CR participation rate [ 21 - 24 ]. Factors within hospitals that contribute to reduced participation in CR include limited access to CR services, with only a small fraction of patients participating in CR.…”

“…Home-based CR enables patients to continue receiving CR after their cardiopulmonary function has been evaluated in hospitals. However, this approach also leads to underutilization [ 22 , 24 , 25 ].…”

“…A survey study aimed at promoting CR participation revealed that healthcare providers underscore the importance of government-provided patient incentives. They perceive the government as playing a pivotal role in ensuring both the time and the right for patients to participate in CR [ 24 ]. There is also a shortage of hospitals that offer CR, indicating a need for government attention and effort to introduce community-based programs that can be managed on an ongoing basis [ 25 ].…”

“…To alleviate the cost burden, expanding insurance coverage could be beneficial. Additionally, various campaigns, studies, and research projects will be necessary to raise awareness about CR and underscore its importance at the government level (Table 2) [21][22][23][24][25].…”