The patient is being readmitted to an inner city hospital for chest pain after being discharged 3 months earlier after having a heart attack. The patient was referred to the hospital's cardiac rehabilitation program after her previous admission The patient states that she began going to cardiac rehabilitation and liked it but stopped. When asked why, she states that, at the beginning, the classes were at 9 AM, but then got switched to 7 PM, when it's dark. The cardiac rehabilitation program was within walking distance of the patient's home. What is the most likely cause of the patient's unwillingness to go to cardiac rehabilitation?
a. Lack of transportation
b. Fear of walking at night
c. Reimbursement issues
d. Noncompliance
ANS: B
A community assessment should be done to determine the level of community violence at night in the patient's neighborhood. She claimed that she liked the program when it was at 9 AM. She did not mention finances as a reason for not going, and the program was within walking distance to her house. Noncompliance is a label given unfairly to patients. Most "noncompliance" is caused. The cause should be identified and dealt with, so the therapy will be successful.
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