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J Cardiopulm Rehabil Prev. 2008 Jul-Aug;28(4):248-52. doi: 10.1097/01.HCR.0000327182.13875.07.

Factors affecting cardiac rehabilitation referral by physician specialty.

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Bethune College, York University, Toronto, Ontario, Canada.



Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists.


A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral.


Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P < .001), lack of standardized referral forms (P < .001), inconvenience (P = .04), program quality (P = .004), and lack of discharge communication from CR (P = .001) as factors negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P < .001).


Where differences emerged, primary care physicians were more likely to perceive factors that would impede CR referral, some of which are modifiable. Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

[Indexed for MEDLINE]

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