Lisa Benz Scott

Disparities in women's referral to and enrollment in outpatient cardiac rehabilitation.

AbstractOBJECTIVE: The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs. DESIGN: Prospective longitudinal design. SETTING: One large academic medical center and two large community hospitals. PATIENTS: A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up. MAIN RESULTS: The rate of referral to outpatients phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P=.03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P=.03). Controlling for age, education, angina class, and comorbidities, women with annual incomes <

Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion

20,000 were 66% less likely to be referred to cardiac rehabilitation (P=.01) and 60% less likely to enroll compared to women with incomes >

Sex bias in referral of women to outpatient cardiac rehabilitation? A meta-analysis

20,000 (P=.01). Although borderline significant, African-American women were 55% less likely to be referred (P=.059) and 58% less likely to enroll (P=.059) than white women. CONCLUSIONS: We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities.

Chronic Stress andAssociated Coping Strategies Among Volunteer EMS Personnel

OBJECTIVES The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence womens referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future womens health research. METHODS Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-review literature. RESULTS The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention. CONCLUSIONS Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect womens participation.

Physical Activity and Rural Middle School Adolescents

Background Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in cardiac rehabilitation (CR), programmes which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists. Methods We searched Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases for studies reporting CR referral rates in women and men published between July 2000 and July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on predefined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE. Results Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) met the inclusion criteria. In the pooled analysis, women (39.6%) were significantly less likely to be referred to CR compared to men (49.4%; odds ratio 0.68, 95% confidence interval 0.62–0.74). Heterogeneity was considered significant (I2 = 90%). There was no change in significant findings when subgroup analyses were conducted, examining fee for service vs. no fee, high-quality studies vs. others, or studies pooled by different study methodologies. Conclusions CR referral remains low for all patients, but is significantly lower for women than men. Evidence-based interventions to increase referral for all patients, including women, need to be instituted. It is time to ensure broader implementation of these strategies.

The Role of Physician Characteristics in Clinical Trial Acceptance: Testing Pathways of Influence

Objective. This study assessed the chronic (everyday) stress experiences andcoping strategies among volunteer Emergency Medical Services personnel. Methods. An anonymous, self-report survey using standardized measures of burnout (the Maslach Burnout Inventory) andcoping (the Coping Mechanisms Checklist) was completed by a convenience sample of volunteer Emergency Medical Services personnel serving one of six participating ambulance companies in Suffolk County, New York. Results. Survey responders included 139 of 175 volunteers who were recruited to participate (response rate = 79%). Alarming percentages of participants scored high on emotional exhaustion (92%) anddepersonalization (99%); however, 75% also reported high levels of personal accomplishment. The use of several coping strategies were concerning. Significant differences were found in coping strategies used between genders andnumber of years served; women were more likely to talk with significant others (97% vs. 81.7%, chi-square = 6.849, p < 0.001), whereas men were more likely to indicate that they pick andchoose calls to go on (67% vs. 49%, chi-square = 4.062, p = 0.044). Participants with 6+ years were more likely than those with fewer years to “keep thoughts/feelings to self” (95.6% vs. 81.2%, chi-square = 5.72, p = 0.017) and“engage in risky behaviors” (47.82% vs. 30.43%, chi-square = 3.68, p = 0.055). Approximately half of responders indicted that they do the bare minimum required to stay an active member of their ambulance company (53%). ANOVAs revealed that use of several coping strategies were significantly associated with depersonalization andpersonal accomplishment scores. Conclusion. Gender, years of experience, the types of coping strategies used, andhigh levels of depersonalization andemotional exhaustion must be considered when developing mental health programs for chronic stress among volunteer Emergency Medical Services personnel.

Alternative models in the delivery of primary and secondary prevention programs.

This study reports the self-reported physical activity level of rural adolescents. Eight hundred and twenty two middle school adolescents (M = 229, F = 593), mean age = 13.9 in three rural Indiana middle schools reported their participation in out-of-school physical activities over a 5 day period. Responses to the activity items were recoded into sedentary, active, and very active exercises and preferred types of exercise. Over one-third (36%) of adolescent males indicated participation in vigorous physical activity less than 2 times per week and almost half (42%) of females reported levels of activity below nationally recommended guidelines. Adolescent males reported more frequent engagement in strength exercises than females (33% and 25% respectively). Over one third of males and females (35%) reported stretching three or more times each week. Significant differences were found between males and females satisfaction with their present body weight such that 21% of males and 44% of females indicated dissatisfaction with their present body weight. Males and females both reported a preference for active team sports such as volleyball, football, softball, and individual activities such as weight training, bicycling, and swimming. The levels of reported activity reflect national survey findings, indicating that many adolescents may not be involved in the recommended levels and that exercise behaviors of rural adolescents may be similar to those in urban areas.

Examining the effect of a patient navigation intervention on outpatient cardiac rehabilitation awareness and enrollment.

ABSTRACT Eight videotaped vignettes were developed that assessed the effects of three physician-related experimental variables (in a 2 × 2 × 2 factorial design) on clinical trial (CT) knowledge, video knowledge, information processing, CT beliefs, affective evaluations (attitudes), and CT acceptance. It was hypothesized that the physician variables (community versus academic-based affiliation, enthusiastic versus neutral presentation of the trial, and new versus previous relationship with the patient) would serve as communication cues that would interrupt message processing, leading to lower knowledge gain but more positive beliefs, attitudes, and CT acceptance. A total of 262 women (161 survivors and 101 controls) participated in the study. The manipulated variables primarily influenced the intermediary variables of post-test CT beliefs and satisfaction with information rather than knowledge or information processing. Multiple regression results indicated that CT acceptance was associated with positive post-CT beliefs, a lower level of information processing, satisfaction with information, and control status. Based on these results, CT acceptance does not appear to be based on a rational decision-making model; this has implications for both the ethics of informed consent and research conceptual models.

Can a brief video intervention improve breast cancer clinical trial knowledge and beliefs

Despite the strong scientific evidence supporting the effectiveness of cardiovascular risk reduction interventions, their application is inconsistent across medical care settings and patient groups. Traditional approaches have been largely ineffective. Thus, there is an urgent need to develop and implement innovative approaches that provide persons with or at risk for coronary heart disease effective risk reduction interventions that are accessible and affordable. Advanced practice nurses and community health workers providing care as members of multidisciplinary teams have been successful strategies for improving outcomes. This paper describes the evidence supporting these alternative models and suggests strategies for the delivery of such programs for the primary and secondary prevention of coronary heart disease.

Health Communication and Professional Preparation: Health Educator Credibility, Message Learning, and Behavior Change

PURPOSE: Awareness of and enrollment in outpatient cardiac rehabilitation (OCR) following a cardiac event or procedure remain suboptimal. Thus, it is important to identify new approaches to improve these outcomes. The objectives of this study were to identify (1) the contributions of a patient navigation (PN) intervention and other patient characteristics on OCR awareness; and (2) the contributions of OCR awareness and other patient characteristics on OCR enrollment among eligible cardiac patients up to 12 weeks posthospitalization. METHODS: In this randomized controlled study, 181 eligible and consenting patients were assigned to either PN (n = 90) or usual care (UC; n = 91) prior to hospital discharge. Awareness of OCR was assessed by telephone interview at 12 weeks posthospitalization, and OCR enrollment was confirmed by staff at collaborating OCR programs. Of the 181 study participants, 3 died within 1 month of hospital discharge and 147 completed the 12-week telephone interview. RESULTS: Participants in the PN intervention arm were nearly 6 times more likely to have at least some awareness of OCR than UC participants (OR = 5.99; P = .001). Moreover, participants who reported at least some OCR awareness were more than 9 times more likely to enroll in OCR (OR = 9.27, P = .034) and participants who were married were less likely to enroll (P = .031). CONCLUSIONS: Lay health advisors have potential to improve awareness of outpatient rehabilitation services among cardiac patients, which, in turn, can yield greater enrollment rates in a program.