Drive time to cardiac rehabilitation: at what point does it affect utilizationReport as inadecuate

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International Journal of Health Geographics

, 9:27

First Online: 04 June 2010Received: 02 February 2010Accepted: 04 June 2010DOI: 10.1186-1476-072X-9-27

Cite this article as: Brual, J., Gravely-Witte, S., Suskin, N. et al. Int J Health Geogr 2010 9: 27. doi:10.1186-1476-072X-9-27


BackgroundA 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation CR is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization.

MethodsA prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants- homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found.

ResultsDrive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 43.3% outpatients, with verified enrollment for 444 36.7% participating in a mean of 86.4 ± 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time ps < .01, but not degree of participation. Logistic regression analysis ps < .001 revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes OR = .26, 95% CI: 0.13-0.55, and the threshold for patient CR enrollment may also be 60 minutes OR = .11, 95% CI: 0.04-0.33.

ConclusionsPhysicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-072X-9-27 contains supplementary material, which is available to authorized users.

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Author: Janette Brual - Shannon Gravely-Witte - Neville Suskin - Donna E Stewart - Alison Macpherson - Sherry L Grace


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