Physician management preferences for cardiac patients: Factors affecting referral to cardiac rehabilitation

BACKGROUND: Cardiac rehabilitation (CR) is an evidence-based intervention that has been shown to reduce both morbidity and mortality. However, CR is widely underused due to multiple factors, including physician referral practices. OBJECTIVES: To describe physicians' preferences in managing cardiac patients and the barriers they face in referring patients to CR. METHODS: A cross-sectional survey of a stratified random sample of 5 10 primary care physicians, cardiologists and cardiovascular surgeons in Ontario was conducted. One hundred seventy-nine physicians responded (40% response rate through repeat mailings) to the survey that investigated medical, demographic and attitudinal factors affecting referral. A hypothetical case scenario that elicited open-ended factors affecting physician management preferences was incorporated. RESULTS: Physicians identified geographic access, uncertainty regarding which provider was responsible for referral and perceptions of patient motivation as important factors affecting referral to CR. Through principal components analysis, several attitudes affecting referral emerged, including beliefs about the efficacy of CR, referral norms, ease of the referral process and desire to manage the patient independently. A hierarchical logistic regression analysis showed that 75% of the variance in referral was attributable to medical specialty, availability of CR and practice norms. CONCLUSIONS: Increased communication among health care providers is needed to ensure CR referral. Due to geographic dispersion, alternatives to site-based CR are necessary to meet the needs of cardiac patients.