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Clark A.M.,University of Alberta | King-Shier K.M.,University of Calgary | Duncan A.,University of Alberta | Spaling M.,University of Alberta | And 4 more authors.
European Journal of Preventive Cardiology | Year: 2013

Background: Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood. Design: We performed a systematic review using qualitative meta-synthesis. Methods: A comprehensive search of 11 databases was conducted. To be included, studies had to contain a qualitative research component wholly or in a mixed method design. Population specific data or themes had to be extractable for referral to programs. Studies had to contain extractable data from adults >18 years and published as full papers or theses during or after 1995. Results: A total of 2620 articles were retrieved: out of 1687 studies examined, 87 studies contained data pertaining to decisions to participate in programs, 34 of which included data on referral. Healthcare professional, system and patient factors influenced referrals. The main professional barriers were low knowledge or scepticism about benefits, an overreliance on physicians as gatekeepers and judgments that patients were not likely to participate. Systems factors related to territory, remuneration and insufficient time and workload capacity. Patients had limited knowledge of programs and saw physicians as key elements of referral but found the process of attaining a referral confusing and challenging. Conclusions: The greatest increases in patient referral to programs could be achieved by allowing referral from nonphysicians or alternatively, automatic referral to a choice of hospital or home-based programs. All referring health professionals should receive educational outreach visits or workshops around the ethical and clinical aspects of programs. © 2012 The European Society of Cardiology.

von Ranson K.M.,University of Calgary | Stevenson A.S.,University of Calgary | Cannon C.K.,Cardiac Wellness Institute of Calgary | Shah W.,Hypertension and Cholesterol Center
Eating Behaviors | Year: 2010

Objective: Two quasi-experimental pilot studies examined eating pathology, eating self-efficacy, shame, guilt, and pride in adults with chronic illness before and after participating in brief cognitive-behavioral psychoeducational groups addressing eating concerns. Method: In Study 1, 60 adults completed assessments before and after a series of two groups; in Study 2, 21 adults also completed an assessment five weeks prior to the first group to identify time-related changes in symptoms. Results: Study 1 participants improved across domains, whereas Study 2 analyses also examining time-related changes showed improvements in eating self-efficacy, shame, guilt, and pride, but not in eating pathology. Discussion: Psychoeducational groups may help improve symptoms including eating pathology, eating self-efficacy, shame, guilt, and pride among chronically-ill adults with eating concerns. © 2009 Elsevier Ltd.

Parker K.,Libin Cardiovascular Institute of Alberta | Parker K.,Foothills Medical Center | Stone J.A.,Libin Cardiovascular Institute of Alberta | Stone J.A.,Foothills Medical Center | And 13 more authors.
Canadian Journal of Cardiology | Year: 2011

Background: Survivors of an acute ST-elevation myocardial infarction (STEMI) remain at high risk for future cardiac events. Cardiac rehabilitation (CR) participation significantly reduces coronary artery disease (CAD) morbidity and mortality risk. Regrettably, poor utilization of CR services post STEMI is common, accentuating a critical action gap in the trajectory of CAD management. The objective of this study was to determine whether integration of an early cardiac access clinic (ECAC), held within 4-14 days of hospital discharge, could improve CR utilization rates following an STEMI. Methods: Between January 2008 and July 2009, 245 consecutively admitted STEMI patients (19.6% female) deemed low risk following early re-establishment of coronary blood flow, were assigned to the ECAC model. An historic comparison group (n=224) was identified based on all STEMI patient admissions at the same tertiary care facility during the 2007 calendar year that met ECAC eligibility criteria. The primary outcomes were rates of CR referral, orientation attendance, program participation, and completion. Results: The ECAC cohort had significantly higher rates of CR referral (100% vs 55.8%, P < 0.0001), orientation attendance (96.3 vs 37.1%, P < 0.0001), program participation (87.8% vs 33.5%, P < 0.0001), and completion (71.4% vs 29.9%, P < 0.001) compared to the matched historical comparison group. Conclusions: The utilization of the ECAC model resulted in an unprecedented (~3-fold) increase in the number of post-STEMI patients participating in CR. Given the unequivocal mortality and morbidity benefits of CR, adoption of the ECAC model has important clinical and economic relevance. © 2011 Canadian Cardiovascular Society.

Campbell T.S.,University of Calgary | Stevenson A.,University of Calgary | Arena R.,University of New Mexico | Hauer T.,Cardiac Wellness Institute of Calgary | And 6 more authors.
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2012

Purpose: Research describing whether stress management can improve clinical outcomes for patients in cardiac rehabilitation (CR) has yielded equivocal findings. Methods: The present investigation retrospectively examined the incremental impact of exercise and stress management (n = 188), relative to exercise only (n = 1389), on psychosocial and physical health outcomes following a 12-week CR program. Results: Participation in stress management and exercise was associated with greater reductions in waist circumference and systolic blood pressure, relative to exercise alone, for patients with baseline clinical elevations on these measures. The stress management group had more depressive symptoms (as measured by the Hospital Anxiety and Depression Scale; t[1] = 3.81, P < .001) and lower physical quality of life (as measured by the 12-Item Short Form Health Survey Physical Component; t[1] = 3.00, P = .003) than the exercise-only group at baseline, but there were no differences between the groups at 12 weeks in terms of depressive symptoms (t[1] = 1.74, P = .082) or physical quality of life (t[1] = 1.56, P = .120). CONCLUSION: These findings suggest that stress management may offer additional benefits in selected patients over and above exercise in CR. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Clark A.M.,University of Alberta | King-Shier K.M.,University of Calgary | Thompson D.R.,Australian Catholic University | Spaling M.A.,University of Alberta | And 6 more authors.
American Heart Journal | Year: 2012

Background: Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood. Methods: A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995. Results: Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients' decisions to attend. The main personal factors affecting attendance after referral included patients' knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influenced patient attendance, including family and, less commonly, health professionals. Regardless of the perceived severity of heart disease, patients could view risk as inherently uncontrollable and any attempts to manage risk as futile. Conclusions: Decisions to attend programs are influenced more by social factors than by health professional advice or clinical information. Interventions to increase patient attendance should involve patients and their families and harness social mechanisms. © 2012 Mosby, Inc.

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