Physician Factors Affecting Cardiac Rehabilitation Referral and Patient Enrollment: A Systematic Review

Abstract

Physicians play an important role in CR referral and enrollment. Despite established benefits and recommendations, cardiac rehabilitation (CR) enrollment rates are pervasively low. The reasons cardiac patients are missing from CR programs are multifactorial and include provider factors. A number of studies have now investigated physician factors associated with referral to CR programs and patient enrollment. The objective of this study was to qualitatively and systematically review this literature. A literature search of MEDLINE, PsycINFO, CINAHL, Embase, and EBM was conducted for published articles from database inception to October 2011. Overall, 17 articles were included following a process of independent review of each article by 2 authors. Seven (41.2%) were graded as good quality according to Downs and Black criteria. There were no randomized controlled trials. Results showed that medical specialty (ie, cardiac specialists more likely to refer; n = 8 studies) and other physician-reported reasons (eg, physician report of their reasons for CR referral and physician sex) were related to referral. Physician factors related to patient enrollment in CR were physician endorsement, medical specialty, being referred, and physician attitudes toward CR. Physician factors are consistently related to CR referral and enrollment. The role of physician endorsements in promoting patient enrollment should be optimized and exploited.

Enablers and Barriers in Delivery of a Cancer Exercise Program: The Canadian Experience

“…In this respect, the physician plays a critical role for the purposes of patient referral and recommendation to cex programs; strategies to support and educate the physician about the benefits and availability of cex programs are consequently justified. Research to further understand physician-related factors that affect referrals and recommendation for cex programs, similar to those already investigated in cardiac rehabilitation 25 , will guide strategies to support physicians and program administrators in facilitating enrolment. With the ever-growing body of empirical literature describing the benefits of cex programming, coordinators could soon encounter less institutional and professional resistance and disinterest.…”

Global availability of cardiac rehabilitation

“…19,95,117,118 Inadequate physician knowledge about CR benefits, lack of incentives to refer and low physician endorsement of CR to their patients have been often described. 95,117 Low physician referral may be compounded by their subjective assessment of a patient's (in)ability to participate, and lack of implementation of systematic CR referral strategies at patient discharge.…”

“…95,117 Low physician referral may be compounded by their subjective assessment of a patient's (in)ability to participate, and lack of implementation of systematic CR referral strategies at patient discharge. 40,119,118 Moreover, compensation for physicians to provide CR is considered much less than that for interventional cardiologists, which likely plays a role in physician choice of specialty and area of practice. This would lead to the systemlevel barrier of lack of health human resource capacity to deliver CR.…”

The impact of the heart failure health enhancement program: A retrospective pilot study

“…In addition to the lack of participation on the part of the patients themselves, one study [14] found that a common barrier to enrollment in cardiac rehab programs was lack of physician referral, even though Medicare reimburses these programs. The literature revealed that additional barriers included patient demographics, patient refusal (due to various reasons), lack of perception of need, lack of transportation and family support [14] .…”

“…In addition to the lack of participation on the part of the patients themselves, one study [14] found that a common barrier to enrollment in cardiac rehab programs was lack of physician referral, even though Medicare reimburses these programs. The literature revealed that additional barriers included patient demographics, patient refusal (due to various reasons), lack of perception of need, lack of transportation and family support [14] . One study [13] suggested the need for changes to the system to enhance referrals, to reduce barriers for prospective patients, and to consider factors that would enhance completion of the HF program that could be incorporated into the HFHEP.…”