Barriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers, and cardiac patients

Thaianne Cavalcante Sérvio,Sherry L Grace,Danielle Aparecida Gomes Pereira,Raquel Rodrigues Britto,Gabriela Lima De Melo Ghisi,Márcia Maria Oliveira Lima,Luciana Duarte Novais Silva,Lilian Pinto Da Silva

doi:10.1186/s12913-019-4463-9

Abstract

BackgroundDespite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its’ worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a low-resource setting.MethodsIn this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale.ResultsThirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01).ConclusionsThe inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed.

Highlights

Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized
Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide, with over 80% of CVD deaths occurring in low- and middle-income countries (LMICs) [1]
Respondents characteristics Ninety-one institutions providing cardiology services were identified across the state of Minas Gerais; of these, 47 (51.6%) were publicly-funded

Summary

Introduction

Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is true in low-resource settings, where the epidemic is at its’ worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a lowresource setting. Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide, with over 80% of CVD deaths occurring in low- and middle-income countries (LMICs) [1]. Dose-response associations are observed [7], it is important that patients enroll, but that they adhere and complete programs to achieve these benefits

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