Drive time to cardiac rehabilitation: at what point does it affect utilization?

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Geographic accessibility is a known barrier to healthcare utilization.
• Cardiac rehabilitation (CR) programs aim to improve cardiovascular health but face challenges with patient access.
• A 30-minute drive time is a commonly used but untested benchmark for healthcare accessibility.

Purpose of the Study:

• To empirically evaluate the drive time threshold for cardiac rehabilitation (CR) utilization.
• To determine if drive time influences CR referral, enrollment, and participation rates.

Main Methods:

• Prospective study of 1209 coronary artery disease outpatients nested within 97 cardiologists.
• Drive times to the nearest CR site were calculated using GIS under various traffic conditions.
• Bivariate and logistic regression analyses assessed the impact of drive time on CR referral, enrollment, and participation.

Main Results:

• Significant differences in CR referral and enrollment were observed based on drive time (p < .01).
• A 60-minute drive time threshold (at 80% of speed limit) was associated with significantly lower physician referral (OR = 0.26) and patient enrollment (OR = 0.11).
• Drive time did not significantly affect the degree of participation once patients were enrolled in CR.

Conclusions:

• Drive time is a significant factor influencing physician referral and patient enrollment in cardiac rehabilitation.
• A 60-minute drive time appears to be a critical threshold impacting CR access.
• Patient adherence to CR participation is not significantly affected by distance once enrollment is achieved.