Underutilization of Cardiac Rehabilitation
Each year, over 1 million Americans have a coronary event or undergo a cardiac-related procedure that qualifies them for CR. Despite this high number, many eligible patients do not receive a referral. While the problem of low referral rates occurs across patient populations, women, minorities, and people with low incomes and education levels are even less likely to be given a referral to CR.
Barriers to referral include gaps in physician awareness of who needs CR and the benefits of it, inconsistency in referral patterns, the absence of a system in hospitals that automatically refers eligible patients, and lack of clinician knowledge about available local programs.
Unfortunately, many patients who are referred to CR do not enroll in a program. Patients often face significant barriers that make CR difficult or unattractive. Some patients do not understand the important benefits of the intervention to their immediate and long-term health. Others may wish to enroll but face practical or logistical challenges such as lack of transportation or inconvenient hours of operation. Patients who live outside of a metropolitan area are 30 percent less likely to participate in CR programs. Still other patients may need help with completing the enrollment process.
The cost of CR is also an enrollment deterrent for some patients. Although Medicare and most private insurers cover the intervention for eligible individuals, patients typically face out-of-pocket costs, including deductibles or copayments. Uninsured patients face the prospect of covering the cost themselves. Individuals with lower incomes are significantly less likely to participate in CR.
Many patients who enroll in CR programs don’t complete the recommended course of 36 one-hour sessions. Reasons for this can include competing work or home responsibilities and transportation concerns. In addition, many programs do not meet the needs of all patients and do not take language and cultural considerations into account.
Although multiple factors contribute to low participation rates in CR, many effective strategies exist that can help hospitals meet the challenges at each stage—referral, enrollment, and retention.
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