Factors associated with female cardiac patient's referral for cardiac rehabilitation
The purpose of the research study was to determine and examine factors that influence referral for cardiac rehabilitation among patients recovering from a cardiac event. In addition, the frequency of female cardiac patients' referral to cardiac rehabilitation was assessed, and referral rates of men and women were compared.
A nonexperimental research design was used to test the hypotheses. Two instruments designed by the investigator, a Medical Records Data Form and a Survey Questionnaire, were used to collect data.
The study sample consisted of 203 men and women hospitalized with at least one of the following diagnoses: coronary artery bypass graft surgery, myocardial infarction, angina, or percutaneous transluminal coronary angioplasty. These patients were thereby eligible for Phase II Cardiac Rehabilitation. The mean age was 60.8 years. After participants were informed verbally and in writing about the purpose and voluntary nature of the study, their hospital records were reviewed and analyzed to obtain the following information: (a) gender; (b) age; (c) ethnicity; (d) insurance coverage; (e) marital status; (f) employment status; (g) proximity of residence to rehabilitation site; (h) transportation availability; (i) concurrent disease processes; (j) domestic/caregiving responsibilities; (k) documentation of referral for cardiac rehabilitation; and (l) attending physician. In addition, patients were sent a survey questionnaire approximately two weeks following their discharge from the hospital. This survey also addressed the aforementioned variables. They were contacted by phone if no response was received after two weeks, and answers to the questions were obtained by phone interview.
Logistic regression was used to determine the power of the independent variables in predicting referral for cardiac rehabilitation, both with the entire sample, and with the female participants. Crosstabulations tables, chi-square analysis, and Phi Coefficients were used to analyze the proposed relationships between referral for cardiac rehabilitation and the categorical variables. Males were found to be referred more often than females, although this finding was not statistically significant. The only variable found to be significant with regards to referral was physician gender. This finding must be viewed with caution because of the small number of female physicians included in the study. It may be a spurious finding; only 15 patients were referred by a female physician. The relationship between gender and referral was stronger than that between ethnicity and referral, although neither was statistically significant. Therefore, the proposed model was not supported.
Because the sample size, especially with regards to the female patients and female physicians, was small, it is difficult to have confidence in the findings. The literature currently reflects conflicting findings regarding the proposed relationships; therefore, they merit further investigation.