Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study (Cardiac Rehabilitation Attitudes and Viewpoints on Engagement)

Abstract

Background: Cardiac rehabilitation (CR), despite numerous evidence of a positive impact on morbidity and mortality, still remains underutilized due to multifactorial reasons. Physician endorsement has been shown to be a very powerful predictor of CR referral. The objective of the study was to describe physicians' attitudes and preferences regarding referral of patients to CR. Methods: A cross-sectional survey of a stratified random sample of 160 physicians specializing in cardiology was conducted at the Philippine Heart Center. One hundred and four physicians responded (65% response rate) to a survey that investigated clinical factors and perceptions affecting referral. Included in the survey was a hypothetical case scenario that elicited open-ended responses affecting physician management preferences. Results: About 78.9% of the physicians stated that they would refer the hypothetical case to CR although there were varied responses in their management practices. The most important factor affecting CR referral was financial limitation, followed by geographic location and issues on program accessibility and benefit. While there is general agreement regarding knowledge of the indications of CR, there is a disparity in the responses with regard to actual referral and management preferences. Conclusions: Financial considerations, accessibility, perceived benefit, and health-care system-related aspects are some of the identified factors that affect physician preferences toward referral to CR. Assessment of physician attitudes and factors affecting CR referral practices provides insight regarding potential targets of improvement to ensure adequate CR referral and provision.