TY - JOUR
T1 - Factors influencing referral to cardiac rehabilitation and secondary prevention programs
T2 - A systematic review
AU - Clark, Alexander M.
AU - King-Shier, Kathryn M.
AU - Duncan, Amanda
AU - Spaling, Melisa
AU - Stone, James A.
AU - Jaglal, Susan
AU - Angus, Jan
N1 - Funding Information:
This work was supported by the Canadian Institutes of Health Research (CIHR) Knowledge Synthesis Grant [KRS-91784].
PY - 2013/8
Y1 - 2013/8
N2 - Background: Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood. Design: We performed a systematic review using qualitative meta-synthesis. Methods: A comprehensive search of 11 databases was conducted. To be included, studies had to contain a qualitative research component wholly or in a mixed method design. Population specific data or themes had to be extractable for referral to programs. Studies had to contain extractable data from adults >18 years and published as full papers or theses during or after 1995. Results: A total of 2620 articles were retrieved: out of 1687 studies examined, 87 studies contained data pertaining to decisions to participate in programs, 34 of which included data on referral. Healthcare professional, system and patient factors influenced referrals. The main professional barriers were low knowledge or scepticism about benefits, an overreliance on physicians as gatekeepers and judgments that patients were not likely to participate. Systems factors related to territory, remuneration and insufficient time and workload capacity. Patients had limited knowledge of programs and saw physicians as key elements of referral but found the process of attaining a referral confusing and challenging. Conclusions: The greatest increases in patient referral to programs could be achieved by allowing referral from nonphysicians or alternatively, automatic referral to a choice of hospital or home-based programs. All referring health professionals should receive educational outreach visits or workshops around the ethical and clinical aspects of programs.
AB - Background: Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood. Design: We performed a systematic review using qualitative meta-synthesis. Methods: A comprehensive search of 11 databases was conducted. To be included, studies had to contain a qualitative research component wholly or in a mixed method design. Population specific data or themes had to be extractable for referral to programs. Studies had to contain extractable data from adults >18 years and published as full papers or theses during or after 1995. Results: A total of 2620 articles were retrieved: out of 1687 studies examined, 87 studies contained data pertaining to decisions to participate in programs, 34 of which included data on referral. Healthcare professional, system and patient factors influenced referrals. The main professional barriers were low knowledge or scepticism about benefits, an overreliance on physicians as gatekeepers and judgments that patients were not likely to participate. Systems factors related to territory, remuneration and insufficient time and workload capacity. Patients had limited knowledge of programs and saw physicians as key elements of referral but found the process of attaining a referral confusing and challenging. Conclusions: The greatest increases in patient referral to programs could be achieved by allowing referral from nonphysicians or alternatively, automatic referral to a choice of hospital or home-based programs. All referring health professionals should receive educational outreach visits or workshops around the ethical and clinical aspects of programs.
KW - Access
KW - decision-making
KW - decisions
KW - health services
KW - inequalities
KW - usage
UR - http://www.scopus.com/inward/record.url?scp=84880319696&partnerID=8YFLogxK
U2 - 10.1177/2047487312447846
DO - 10.1177/2047487312447846
M3 - Review article
C2 - 23847263
AN - SCOPUS:84880319696
SN - 2047-4873
VL - 20
SP - 692
EP - 700
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 4
ER -