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- Title
Clinical effectiveness of cardiac rehabilitation and barriers to completion in patients of low socioeconomic status in rural areas: A mixed-methods study.
- Authors
Beleigoli, Alline; Dafny, Hila Ariela; Pinero de Plaza, Maria Alejandra; Hutchinson, Claire; Marin, Tania; Ramos, Joyce S.; Suebkinorn, Orathai; Gebremichael, Lemlem G.; Bulamu, Norma B.; Keech, Wendy; Ludlow, Marie; Hendriks, Jeroen; Versace, Vincent; Clark, Robyn A.
- Abstract
Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes.
- Subjects
AUSTRALIA; HEART diseases; MORTALITY; QUALITATIVE research; RESEARCH funding; SOCIOECONOMIC status; LOGISTIC regression analysis; INTERVIEWING; PATIENT readmissions; RETROSPECTIVE studies; ANXIETY; DESCRIPTIVE statistics; ODDS ratio; THEMATIC analysis; DISEASES; RURAL conditions; RESEARCH methodology; ABILITY; NEEDS assessment; CONFIDENCE intervals; CARDIAC rehabilitation; SOCIAL classes; MENTAL depression; TRAINING
- Publication
Clinical Rehabilitation, 2024, Vol 38, Issue 6, p837
- ISSN
0269-2155
- Publication type
Article
- DOI
10.1177/02692155241236998