Access to cardiac rehabilitation among South-Asian patients by referral method: a qualitative study.

People of South-Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South-Asian patients. Participants were South-Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one offour methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive-descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants'needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient-provider communication.

Degree and correlates of cardiac knowledge and awareness among cardiac inpatients.

OBJECTIVE: To investigate the degree of CHD awareness as well as symptom, risk factor, and treatment knowledge in a broad sample of cardiac inpatients, and to examine its sociodemographic, clinical and psychosocial correlates. METHODS: 1308 CHD inpatients (351 [27.0%] female), recruited from 11 acute care sites in Ontario, participated in this cross-sectional study. Participants were provided with a survey which included a knowledge questionnaire among other measures, and clinical data were extracted from medical charts. RESULTS: 855 (68.8%) respondents cited heart disease as the leading cause of death in men, versus only 458 (37.0%) in women. Participants with less than high school education (p<.001), an annual family income less than $50,000CAD (p=.022), low functional capacity (p=.042), who were currently smoking (p=.022), who had no family history of heart disease (p<.001), and who had a perception of low personal control (p=.033) had significantly lower CHD knowledge. CONCLUSIONS: Awareness of CHD is not optimal, especially among women, South Asians, and those of low socioeconomic status. CHD patients have a moderate level of disease knowledge overall, but greater education is needed. PRACTICE IMPLICATIONS: Tailored educational approaches may be necessary for those of low socioeconomic status, particularly with regard to the nature of CHD, tests and treatments.

Primary care provider receipt of cardiac rehabilitation discharge summaries: are they getting what they want to promote long-term risk reduction?

BACKGROUND: Communication between cardiac rehabilitation (CR) and primary care providers (PCPs) is paramount to promoting long-term risk reduction after the completion of CR. The objectives of this study were to investigate receipt of CR discharge summaries by PCPs, as well as timing, and satisfaction with and perceptions of CR summaries. METHODS AND RESULTS: Five hundred seventy-seven eligible PCPs of consenting enrollees from 8 regional or urban Ontario CR programs were invited to participate in this cross-sectional study. Discharge summaries were tracked from the CR program to the PCP's office. PCPs who received a summary were mailed a survey assessing their perceptions of the summaries. Of the 138 (24.0%) eligible consenting PCPs, 71 (51.5%) received CR discharge summary, of whom 64 (90.1%) completed the survey. All PCPs desired to receive discharge summaries, with most wanting it transmitted via fax (n=38, 61.3%). Forty-seven (77.1%) PCPs reported they had or will use information in the summary for patient care. PCPs who did not receive the discharge summary in advance of their patient's first post-CR visit (n=7, 10.9%) were significantly less likely to use it in patient care (P<0.01). On a 5-point Likert scale, PCPs rated medication (4.65±0.74), patient care plan (4.43±0.87), and clinical status (4.33±0.94) as most important to include in a CR discharge summary. These were not provided in 18.8% (n=12), 4.7% (n=3), and 22.2% (n=14) of summaries, respectively. CONCLUSIONS: Approximately half of CR discharge summaries reach PCPs, revealing a large gap in continuity of patient care.