A Mixed Methods Study of Continuity of Care from Cardiac Rehabilitation to Primary Care Physicians

Background: Participation in cardiac rehabilitation (CR) programs results in multiple beneficial outcomes, including decreased morbidity and mortality. In Canada, the involvement of the primary care physician post-CR should increase the likelihood of sustaining the benefits achieved by CR and enhance the continuity of care that cardiac patients receive.

Objectives: To identify and describe information that is transferred from CR programs to primary care physicians in discharge summaries, and to assess the usefulness of such information from the perspective of the primary care physician.

Methods: For each of 21 Ontario CR sites to which patients from a larger study were referred, up to four primary care physicians were contacted to request a copy of the CR discharge summary received and their participation in a telephone interview. Discharge data were coded and enumerated. Qualitative data from 17 interviews were transcribed and coded based on grounded analyses.

Results: Of the 89 primary care physicians approached, 50 participated (response rate of 61.7%). Twenty-one physicians (42.0%) received the intended discharge summary from the CR site. There was great variability in clinical and service data reported, with 52.0% reporting an exercise prescription for the home or community and 42.0% reporting current medications prescribed. Four themes requiring improvement were generated from the physician interviews: patient behavioural management issues, health system factors, efficiency of data transfer and communication issues.

Conclusions: Major inconsistencies were noted between clinical data communicated versus what was desired. Data relating to attendance rates, behavioural management suggestions and lipid values were among the most notable omissions.