Study finds cardiac rehab information not getting back to family doctors

Almost 60 per cent of family doctors do not receive basic information about their patients’ health at the end of a cardiac rehabilitation program, making it more difficult to provide good followup care, according to a study led by York and the Peter Munk Cardiac Centre at the University Health Network (UHN).

“Primary care physicians need to know information such as a patient’s exercise capacity and blood pressure when they start and when they finish a cardiac rehabilitation program. In many cases they are not being sent that information,” says Sherry Grace, a professor in York’s School of Kinesiology & Health Science. Grace worked on the study at UHN with former York graduate student Dana Riley (MA ’06), and others.

The study, “A Mixed Methods Study of Continuity of Care from Cardiac Rehabilitation to Primary Care Physicians,” was published today in the June 2009 issue of The Canadian Journal of Cardiology, the official journal of the Canadian Cardiovascular Society. It concludes that details about the patient’s health status, recommendations for ongoing modification of risk factors, medication changes and other information should be sent to primary care physicians in a standardized discharge summary.

Right: Sherry Grace

The sampling of discharge summaries currently sent out to physicians in Ontario and elsewhere showed that only 42 per cent included a list of the patient’s current medications. Only 24 per cent of doctors were sent information about the patient’s personalized rehabilitation plan. In many cases, the discharge report was sent only to the cardiologist, rather than the family doctor who was more likely to be seeing the patient regularly.

Heart disease is the leading cause of death in the developed world. Cardiac rehabilitation, which includes exercise, education and counselling, has been shown to decrease death rates by 25 per cent, among other benefits.

Involving family doctors in the care of the patient should increase the likelihood of sustaining the benefits from cardiac rehabilitation, the study concludes, and promote continuity of care for the patient. It should also reduce duplication of services and tests.

Family doctors were asked what they wanted in discharge summaries to support their long-term care of heart patients. They recommended implementing standardized cardiac rehabilitation discharge summaries, and delivering them electronically. They responded that in addition to basic contact information, the summary should include cholesterol values and exercise tolerance, weight, waist circumference, medication information, symptoms that occur with physical exertion, and details about how much the patient participated in the program and whether it included nutrition, smoking and psychosocial counseling.