Factors Associated With Utilization of Cardiac Rehabilitation Among Patients With Ischemic Heart Disease in the Veterans Health Administration: A QUALITATIVE STUDY. Issue 3 (May 2016)

• Record Type: Journal Article
• Authors: Schopfer, David W.; Priano, Susan; Allsup, Kelly; Helfrich, Christian D.; Ho, P. Michael; Rumsfeld, John S.; Forman, Daniel E.; Whooley, Mary A.
• Is Part Of: Journal of cardiopulmonary rehabilitation and prevention. Volume 36:Issue 3(2016)
• Publication Date: 2016-05
• Subjects: cardiac rehabilitation -- program delivery -- qualitative -- utilization; Cardiopulmonary system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Cardiopulmonary system -- Diseases -- Prevention -- Periodicals; 616.103
• DOI: 10.1097/HCR.0000000000000166
• Languages: English
• ISSNs: 1932-7501

Abstract

Abstract : BACKGROUND: Cardiac rehabilitation (CR) programs reduce morbidity and mortality in patients with ischemic heart disease but are vastly underutilized in the United States, including the Veterans Health Administration (VA) Healthcare System. Numerous barriers affecting utilization have been identified in other health care systems, but the specific factors affecting Veterans are unknown. We sought to identify barriers and facilitators associated with utilization of CR in VA facilities. METHODS: We performed a qualitative study of 56 VA patients, providers, and CR program managers at 30 VA facilities across the United States. We conducted semistructured interviews with key informants to explore their attitudes and knowledge toward CR. Interviews were conducted until thematic saturation occurred. Analyses using grounded theory to identify key themes were conducted using the qualitative data analysis package ATLAS.ti. RESULTS: We identified 6 themes as barriers and 5 as facilitators. The most common barriers to participation in CR were patient transportation issues (68%), lack of patient willingness to participate (41%), and no access to a nearby VA hospital with a CR program (30%). The most common facilitators were involvement of a dedicated provider or "clinical champion" (50%), provider knowledge of or experience with CR (48%), and patient desire for additional medical support (32%). CONCLUSIONS: Our findings suggest that addressing access issues and educating and activating providers on CR may increase utilization of CR programs. Targeting these specific factors may improve utilization of CR programs. Abstract : Supplemental Digital Content is Available in the Text.Barriers affecting utilization of cardiac rehabilitation programs have not been identified in the Veterans Health Administration Healthcare System. We performed a qualitative study of 56 patients and providers and identified the major barriers and facilitators. Addressing access issues and activating providers may increase utilization of cardiac rehabilitation programs.