Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study (Cardiac Rehabilitation Attitudes and Viewpoints on Engagement)

Cuenza, Lucky R.; Gacrama, Edward Nino; Tan, Kent Anthony; Quito, Benjamin Jose; Ebba, Edgardo

doi:10.4103/2250-3528.186490

Cited by 3 publications

(3 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study at the PHC identified financial considerations, accessibility, perceived benefit and health-care system–related aspects as factors affecting physician referral practices. 22 Second, we need to understand why only 1 in 10 patients is enrolling despite referral, even when it is covered (e.g., distance). With this knowledge, appropriate strategies to overcome them could be instituted, such as home/electronic-based CR where covered.…”

Section: Discussionmentioning

confidence: 99%

Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study

Miralles-Resurreccion

Grace

Cuenza

2022

J Cardiovasc Thorac Res

View full text Add to dashboard Cite

Introduction: Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment. Methods: This is a retrospective cohort study assessing cardiac patients referred to CR at a tertiary center in Southeast Asia from 2013 to 2019. The paper-based pathway was introduced at the end of 2012. The checklist with automatic CR referral on the third day post-operation prompted a nurse to educate the patient about CR, initiate phase 1 and encourage enrollment in phase 2. Patients who were not eligible for the pathway for administrative or clinical reasons were referred at the discretion of the attending physician (i.e., usual care). Enrollment was defined as attendance at≥1 CR visit. Results: Of 4792 patients referred during the study period, 394 enrolled in CR. Significantly more patients referred automatically enrolled compared to usual care (225 [11.8%] vs. 169 [5.8%]; OR=2.2, 95% CI=1.8-2.7), with increases up to 23.4% enrollment in 2014 (vs. average enrollment rate of 5.9% under usual referral). Patients who enrolled following automatic referral were significantly younger and more often employed (both P<0.001); no other differences were observed. Conclusion: In a lower-resource, Southeast Asian setting, automatic CR referral is associated with over two times greater enrollment in phase 2 CR, although efforts to maintain this effect are required.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study

Miralles-Resurreccion

Grace

Cuenza

2022

J Cardiovasc Thorac Res

View full text Add to dashboard Cite

show abstract

“…Several studies on providers barriers to refer patients to CR [ 36 ] have demonstrated that physicians’ attitude and behavior are key factors affecting patient’s adherence to the program. According to one systematic review, the strength of the primary care physician recommendations is highly correlated with patients’ adherence to CR [ 29 ]. One study published in the Journal of the American College of Cardiology in 2009, found that the strongest determinant of patient participation in CR is the strength of the recommendation of the physician making the referral.…”

Section: Discussionmentioning

confidence: 99%

“…One study on physician attitudes toward CR in the Philippines has shown that lower CR enrollment is correlated with cardiologists who are more uncertain about the benefits of a CR program [ 29 ]. As reported in a systematic literature review, a large study conducted on 22 666 cardiac inpatients eligible for CR, found that patients who enrolled in a program received strong physician support to start CR, whereas those who did not enroll received either a weak or no recommendation at all [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and practices survey of cardiac rehabilitation among cardiologists and cardiac surgeons in Lebanon

2021

View full text Add to dashboard Cite

Background Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low and middle-income countries. Despite the benefits, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics. This first national survey on CR in Lebanon assesses the knowledge, attitudes and practices among physicians. In addition, the study identifies what the main barriers to access to CR are and provides suggestions for the implementation of CR in the country. Results The response rate was 41.5% (n = 83). Results show that the cardiologists have medium level of knowledge about CR and its multidisciplinary content. Physicians support the implementation of a comprehensive CR program in the country. 50% of the physicians recommended first to solve the financial issues before implementing a CR program. Supplementary learning about the benefits of CR is highly recommended to enroll more patients with CVD into CR. In addition, the lack of specialists in the field, lack of motivation for patients to enroll to CR and inconvenient location of the rehabilitation centers were identified as major barriers by the respondents. Conclusions The role of physicians in promoting patient enrolment should be optimized and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed to provide evidence on the CR benefits in Lebanon and to motivate policy-makers to place priority on the establishment of a comprehensive CR program in the country.

show abstract

Translation, Cultural Adaptation of the Portuguese Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-P) Scale and Assessment of Its’ Measurement Properties

Cruz,

Vanderlei,

Takarashi

et al. 2024

Healthcare

View full text Add to dashboard Cite

Background/Objectives: Access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factors influencing CR referral in a Latin American context for the first time. Methods: The PACRR was translated into Brazilian Portuguese through a rigorous process involving independent translation, back-translation, and expert panel review to ensure face, content, and cross-cultural validity. A total of 44 Brazilian physicians completed the questionnaire, allowing for an assessment of internal consistency, criterion validity, and convergent validity. Results: The findings confirmed the face, content, and cultural validity of the 20 translated items, with a mean item clarity rating of 4.8/5. The final version included 17 of the original 19 PACRR-P items, with a Cronbach’s alpha of 0.73. Referral rates were significantly associated with over one-third of the PACRR-P items, preliminarily supporting the scale’s criterion validity, while correlations with the ReCaRe scores further supported its convergent validity. The most prominent barriers to referral were a lack of familiarity with CR site locations, absence of a standard referral form, and lack of automatic referral processes. Conclusions: The PACRR’s validity and reliability among Portuguese-speaking providers are preliminarily supported.

show abstract

Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study (Cardiac Rehabilitation Attitudes and Viewpoints on Engagement)

Cited by 3 publications

References 2 publications

Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study

Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study

Knowledge, attitudes and practices survey of cardiac rehabilitation among cardiologists and cardiac surgeons in Lebanon

Translation, Cultural Adaptation of the Portuguese Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-P) Scale and Assessment of Its’ Measurement Properties

Contact Info

Product

Resources

About