Int J Health Geogr - Drive time to cardiac rehabilitation: at what point does it affect utilization?

Tópicos

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Resumo

CKGROUND: A 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation (CR) is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization.METHODS: A prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants' homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found.RESULTS: Drive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 (43.3%) outpatients, with verified enrollment for 444 (36.7%) participating in a mean of 86.4 +/- 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time (ps < .01), but not degree of participation. Logistic regression analysis (ps < .001) revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes (OR = .26, 95% CI: 0.13-0.55), and the threshold for patient CR enrollment may also be 60 minutes (OR = .11, 95% CI: 0.04-0.33).CONCLUSIONS: Physicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.

Resumo Limpo

ckground minut drive time threshold often cite indic access health servic cardiac rehabilit cr chronic diseas manag program design enhanc maintain cardiovascular health geograph barrier util often cite purpos studi empir test drive time threshold cr utilizationmethod prospect studi use multilevel design coronari arteri diseas outpati nest within cardiologist particip complet baselin sociodemograph survey report cr referr enrol particip second survey month later cr util verifi cr site geograph inform system use generat drive time speed limit closest cr site particip home take consider various traffic condit bivari analysi use test differ cr referr enrol degre particip drive time logist regress use test drive time increment signific differ foundresult drive time generat outpati overal cr referr verifi outpati verifi enrol particip mean prescrib session signific differ cr referr enrol drive time ps degre particip logist regress analysi ps reveal drive time threshold post speed limit physician referr may minut ci threshold patient cr enrol may also minut ci conclus physician may take geographi consider refer patient cr empir consider also reveal patient signific less like enrol cr must drive minut closest program enrol distanc signific effect degre particip

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