Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

BMJ Open - Tập 6 Số 3 - Trang e010214 - 2016
Sobia Ali-Faisal1,2, Lisa Benz Scott1, Lauren Johnston3, Sherry L. Grace3
1Stony Brook University, Program in Public Health, Stony Brook Medicine, School of Health, Technology and Management, Stony Brook, New York, USA
2York University, Toronto, Ontario, Canada
3School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

Tóm tắt

ObjectivesTo describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment.Setting3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre.ParticipantsCR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants.InterventionThe PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers.Outcome measuresThe primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction.ResultsThose who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24).ConclusionsThere is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest to their home.Trial registration numberNCT02204449; Results.

Từ khóa


Tài liệu tham khảo

Mendis S , Puska P , Norrving B , eds. Global Atlas on cardiovascular disease prevention and control. Geneva: World Health Organization, 2011.

10.1016/j.jacc.2015.10.044

10.1038/nrcardio.2014.98

10.1177/2047487314520783

10.1016/j.ahj.2005.03.034

10.1177/2047487312447846

Clark, 2012, A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral, Am Hear J, 164, 835, 10.1016/j.ahj.2012.08.020

10.1161/CIR.0b013e318246b1e5

Balady, 1994, Cardiac rehabilitation programs: a statement for healthcare professionals from the American Heart Association, Circulation, 90, 1602, 10.1161/01.CIR.90.3.1602

10.1001/archinternmed.2010.501

Gravely-Witte, 2010, Effects of cardiac rehabilitation referral strategies on referral and enrollment rates, Nat Rev, 7, 87

10.1016/j.cjca.2010.12.007

10.1097/HCR.0b013e31823be13b

Grace, 2012, CRCARE Investigators. Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: A prospective, multi-site study, Implement Sci, 7, 120, 10.1186/1748-5908-7-120

Benz Scott, 2013, Examining the effect of a patient navigation intervention on outpatient cardiac rehabilitation awareness and enrollment, J Cardiopulm Rehabil Prev, 33, 281, 10.1097/HCR.0b013e3182972dd6

Benz Scott, 2013, Effect of patient navigation on enrollment in cardiac rehabilitation, JAMA Intern Med, 173, 244, 10.1001/2013.jamainternmed.1042

Freeman, 2013, The history, principles, and future of patient navigation: commentary, Semin Oncol Nurs, 29, 72, 10.1016/j.soncn.2013.02.002

10.1207/s15430154jce2101s_4

Bradford, 2007, HIV System Navigation: an emerging model to improve HIV care access, AIDS Patient Care STDS, 21, S49, 10.1089/apc.2007.9987

10.2337/diaspect.24.1.9

10.2215/CJN.11731111

10.1007/s11606-012-2044-2

10.3322/caac.20111

10.1097/NCC.0b013e3181c40401

10.1002/cncr.23815

Whop, 2012, Navigating the cancer journey: a review of patient navigator programs for Indigenous cancer patients, Asia Pac J Clin Oncol, 8, e89, 10.1111/j.1743-7563.2012.01532.x

10.1161/CIRCOUTCOMES.115.002292

Benz Scott, 2010, A call for intervention research to overcome barriers to women's enrollment in outpatient cardiac rehabilitation programs, J Womens Health (Larchmt), 19, 1951, 10.1089/jwh.2010.2416

10.1177/1740774512450097

10.1186/1471-2288-10-67

Stone J , Suskin N , Arthur H . Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention: translating knowledge into action. 3rd edn. Winnipeg, MB, Canada: Canadian Association of Cardiac Rehabilitation, 2009.

Brady, 2013, Clinical and sociodemographic correlates of referral for cardiac rehabilitation following cardiac revascularization in Ontario, Hear Lung, 42, 320, 10.1016/j.hrtlng.2013.07.001

British Heart Foundation. The National Audit of Cardiac Rehabilitation Annual Statistical Report 2013 beating heart disease together. 2013.

Taylor, 2014, Exercise-based rehabilitation for heart failure, Cochrane Database Syst Rev, 4, CD003331

Rehabilitation AA of C and P, ed. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 5th edn. Chicago: American Association of Cardiovascular and Pulmonary Rehabilitation, 2013.

Forman, 2015, Rehabilitation practice patterns for patients with heart failure: the United States perspective, Heart Fail Clin, 11, 89, 10.1016/j.hfc.2014.08.010

Health Quality Ontario and Ministry of Health and Long Term Care. Quality-based procedures: clinical handbook for heart failure (acute and postacute). Toronto: Health Quality Ontario, 2015. http://www.hqontario.ca/evidence/evidence-process/episodes-of-care#community-chf

Thông tin
Thông tin xuất bản

BMJ Open

Tập 6 Số 3

e010214

Thông tin tác giả