School of Kinesiology and Health Science
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Browsing School of Kinesiology and Health Science by Author "29b404dda5191f6c1356e54f359ba6b6"
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Item Open Access Access to cardiac rehabilitation among South Asian patients by referral method: A qualitative study(2010-05) Grewal, Keerat; Leung, Yvonne; Safai, Parissa; Stewart, Donna Eileen; Anand, Sonia; Gupta, Milan; Parsons, Cynthia; Grace, Sherry L.OBJECTIVES: South Asians (SA) suffer an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, SA are among the least likely to participate. ‘Automatic’ referral increases CR utilization and may reduce access inequalities. METHODS: This study qualitatively explored whether CR referral knowledge/access varied by referral method among SA patients. Participants were SA cardiac patients from Ontario hospitals. Each hospital refers to CR through one of four methods: automatically through paper or electronically; through discussion with allied health professionals (liaison referral); or through usual referral at physician discretion. Data was collected via interviews and analyzed using Interpretive-descriptive analysis. RESULTS: Four themes emerged: 1) importance of pre-discharge CR discussions with health care providers; 2) limited knowledge of CR; 3) ease of referral process as facilitator of CR attendance; 4) participants’ need for personal autonomy over decision to attend CR. CONCLUSION: Liaison referral was perceived to be the most suitable method of referral for participants. It facilitated communication between patients and providers, ensuring improved CR understanding. Automatic referral may be less suited for this population, due to reduced patient-provider communication.Item Open Access Effect of Referral Strategies on Access to Cardiac Rehabilitation Among Women(2014-06-11) Gravely, Shannon; Anand, Sonia; Stewart, Donna Eileen; Grace, Sherry L.Background: Despite its proven benefits and need, women’s access to cardiac rehabilitation (CR) is suboptimal. Referral strategies, such as systematic referral, have been advocated to improve access to CR. This study examined sex differences in CR referral and enrollment by referral strategies; and the impact of referral strategies for referral and enrollment concordance among women. Design: Prospective cohort study. Methods: This prospective study included 2635 coronary artery disease inpatients from 11 Ontario hospitals that utilized 1 of 4 referral strategies. Participants completed a sociodemographic survey, and clinical data were extracted from charts. One year later, 1809 participants (452 [25%] women) completed a mailed survey that assessed CR utilization. Referral strategies were compared among women using generalized estimating equations to control for effect of hospital. Results: Overall, significantly more men than women were referred (67.2% and 57.8% respectively, p<.001), and enrolled in CR (58.6% and 49.3% respectively, p=.001). Of the retained women, combined systematic and liaison-facilitated referral resulted in significantly greater CR referral (Odds Ratio [OR]=10.3, 95% Confidence Interval [CI] = 4.11-25.58) and enrollment (OR=6.6, 95% CI = 4.34-9.92) among women when compared to usual referral. Conversely, concordance between referral and enrollment was greatest following usual referral (=.85), and decreased with referral intensity. Conclusions: While a lower proportion of referred patients enroll, systematic and liaison-facilitated inpatient referral strategies result in the greatest CR enrolment rates among women. Such strategies have the potential to improve access among women, and reduce “cherry picking” of patients for referral.