Background
One of the key drivers of cardiac rehabilitation under-utilisation is physician referral
failure. The Physician Attitudes toward Cardiac Rehabilitation & Referral (PACRR)
scale was developed to understand factors that impact their referral practices, so
they can be ultimately reliably be identified and mitigated. The objectives of this
study were to assess the reliability, factor structure, and validity of the PACRR.
Methods
Data were retrospectively analysed from three cohorts administering the PACRR, a 19-item
scale. The first cohort consisted of 185 cardiologists or family physicians; the second
of 51 of the same, and the third of 97 cardiologists. Internal consistency was assessed
by Cronbach's alpha, factor structure by confirmatory factor analysis, construct validity
by significant differences in PACRR scores by physician specialty, and criterion validity
by testing for significant differences in PACRR scores by referral.
Results
Cronbach’s alpha was 0.81, 0.71, and 0.69 in each of the three cohorts, respectively.
Factor analysis in the latter two cohorts revealed four factors: referral norms, preference
to manage patients independently of cardiac rehabilitation (CR), perceptions of program
quality, and referral processes. Construct validity was established in the first cohort,
as significant differences in PACRR scores were found by physician specialty. Criterion
validity was supported by significant differences in mean scores by referral in each
cohort. Physicians rated bad experiences with CR programs, poor program quality, skepticism
of CR benefits and lack of familiarity with local programs as the most important factors
that affected their referral to CR.
Conclusions
In conclusion, the PACRR scale was demonstrated to have good reliability and validity.
Keywords
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Article info
Publication history
Published online: July 18, 2018
Accepted:
July 2,
2018
Received in revised form:
June 5,
2018
Received:
December 12,
2017
Identification
Copyright
© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
