AIM: Auto referrals + patient convos boost CV rehab rates 45%

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Combining automatic referrals with patient discussions can boost the rates of cardiac rehabilitation. With wider adoption strategies, 45 percent more patients with cardiac disease could be treated with access to the benefits of cardiac rehabilitation, according to a study published in the Feb. 14 issue of the Annals of Internal Medicine.

“Cardiac rehabilitation (CR) offers a comprehensive approach to chronic disease management, by addressing these risk factors,” which include hypertension, dyslipidemia, obesity, smoking, unhealthy diet and a sedentary lifestyle, the authors wrote. “Indeed, there is sound evidence demonstrating that CR participation significantly reduces morbidity and mortality by approximately 25 percent over one to two years when compared with usual care.” However, prescribing CR in combination with medications is not standard practice.

Sherry L. Grace, PhD, of the school of kinesiology and health science at York University in Toronto and Women’s Health Program in the University Health Network in Toronto, and colleagues evaluated 2,635 patients with coronary artery disease to assess four referral strategies—automatic, liaison, combined automatic and liaison and "usual referral"—to determine the effects on CR referral and utilization.

Information was collected through sociodemographic surveys and medical charts from 11 Ontario hospitals using the aforementioned referral-based strategies.

After one year of study recruitment, 1,809 patients completed follow-up surveys--14.8 percent were deemed ineligible.

The researchers reported that combined automatic and liaison referral showed the greatest number of CR use, 85.8 percent were referred and 73.5 percent of patients were enrolled. Automatic referrals followed with 70.2 patients being referred and 60 percent enrolling. For liaison-only referrals, 59 percent of patients were referred and 50.6 percent were enrolled.

The researchers reported that the degree of CR participation did not differ by referral strategy among referred patients.

However, “the combined referral strategy was related to significantly greater referral and enrollment than either the automatic or liaison strategy alone,” the authors noted.

Despite the fact that quality improvement initiatives have recently been implemented to increase CR, the practice remains highly underutilized, “primarily due to low rates of referral,” the authors wrote.

When combined automatic and liaison referral strategies were used, the likelihood of referral increased eight-fold, with more than 70 percent of patients enrolling in the evidence-based programs.

“The rates of CR referral and enrollment observed in this study are encouraging,” the authors wrote. In fact, implementing referral strategies such as these has the potential to raise CR use by 45 percent.

“Institutions should be encouraged to adopt such quality improvement initiatives, using established techniques to promote dissemination and implementation,” the authors concluded. “While wider adoption of these CR referral strategies would potentially improve the health of many patients being treated for cardiac disease, new funding and service delivery models should be explored to mitigate effects on capacity and wait times.”