Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study

• Published in: São Paulo medical journal Vol. 140; no. 1; pp. 108 - 114
• Main Authors: Borges, Giovanna Lombardi Bonini, Cruz, Mayara Moura Alves da, Ricci-Vitor, Ana Laura, Silva, Paula Fernanda da, Grace, Sherry Lynn, Vanderlei, Luiz Carlos Marques
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 01-01-2022; Associação Paulista de Medicina
• Subjects: Barriers to cardiac rehabilitation; Brazil; Cardiac Rehabilitation; Cardiovascular diseases; Cross-Sectional Studies; Delivery of Health Care; Humans; MEDICINE, GENERAL & INTERNAL; Original; Patients’ characteristics; Private sector; Public healthcare system; Public sector; Surveys and questionnaires; Brazil; Surveys and questionnaires; Barriers to cardiac rehabilitation; Cardiac rehabilitation; Delivery of health care; Cardiovascular diseases; Public healthcare system; Patients’ characteristics; Private sector; Public sector
• ISSN: 1516-3180; 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2020.0782.R1.31052021

Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges.
To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence.
Observational, cross-sectional study in public and private CR programs offered in Brazil.
Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale.
From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012).
Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.