PMID- 19278299
OWN - NLM
STAT- MEDLINE
DCOM- 20090428
LR  - 20090312
IS  - 1445-6354 (Electronic)
IS  - 1445-6354 (Linking)
VI  - 9
IP  - 1
DP  - 2009 Jan-Mar
TI  - Identification of barriers to the implementation of evidence-based practice for 
      pre-hospital thrombolysis.
PG  - 1100
AB  - INTRODUCTION: Thrombolysis for patients with an ST elevation myocardial 
      infarction (STEMI) is most effective if given promptly. In remote areas, 
      pre-hospital thrombolysis has been shown to be effective and reduce mortality. 
      However, pre-hospital thrombolysis may offer advantages even in urban areas in 
      terms of reduced 'call to needle' times. General practitioners' attitudes are 
      crucial in the delivery of this service. Differences in perceptions between rural 
      or remote and urban GPs have not been examined previously. The aim of this study 
      was to investigate the attitudes and beliefs of GPs with a view to pre-empting 
      potential barriers to service redesign. METHODS: A questionnaire was sent by 
      email and conventional post to all local GPs (n = 261) located in the study area 
      (Highland Region in the North of Scotland). Data were entered into an Excel 
      spreadsheet for statistical analysis. For the purposes of further analysis the 
      data were divided into three groups: 'urban', 'rural' and 'undefined'. Data were 
      analysed by either unpaired Student's t-test or chi(2) statistic as appropriate, 
      with significance taken at the 5% level. Qualitative responses were grouped 
      following thematic analysis. RESULTS: There was a 49% (n = 127) response. More 
      questionnaires were returned by conventional post than email (106 vs 21, p < 
      0.0001). There did not appear to be a relationship between confidence in giving 
      pre-hospital thrombolysis and number of years worked as a GP. Rural GPs who had 
      previously administered pre-hospital thrombolysis reported higher confidence 
      compared with GPs who had never given pre-hospital thrombolysis (7.5 +/- 1.7 vs 
      6.3 +/- 2.0, p = 0.01). Responses to two open questions: 'What do you think are 
      the main factors preventing delivery of pre-hospital thrombolysis?' and 'What 
      more could be done to increase your own willingness to administer pre-hospital 
      thrombolysis?' were classified into four areas: training, experience, 
      organisational and equipment issues. CONCLUSIONS: Several potential barriers to 
      improving the uptake of pre-hospital thrombolysis were highlighted and included 
      training, experience, equipment and organisational factors. Rural GPs were more 
      likely to be confident to give thrombolysis. To implement pre-hospital 
      thrombolysis in areas closer to hospitals may require greater support and 
      training of urban GPs, who reported lower confidence in ECG analysis. Many GPs, 
      while under-confident, reported a desire for further training to improve skills. 
      Other GPs clearly stated that they did not consider emergency treatment of 
      myocardial infarction in terms of thrombolysis as part of their role and that the 
      treatment of acute STEMI in the community should be performed by the ambulance 
      service. This view was held by urban rather than rural GPs. In remote areas it is 
      clear that lack of ambulance crews and poor communication between the ambulance 
      service and GPs leads to instances of 'scoop and run' to hospital, even when the 
      distances are considerable and local GPs have the ability and desire to 
      administer pre-hospital thrombolysis. Clear local clinical care pathways are 
      recommended.
FAU - Bloe, Charles
AU  - Bloe C
AD  - Coronary Care Unit, Raigmore Hospital, Inverness, Scotland, UK. 
      Charles.bloe@nhs.net
FAU - Mair, Chris
AU  - Mair C
FAU - Call, Andrew
AU  - Call A
FAU - Fuller, Andrew
AU  - Fuller A
FAU - Menzies, Sue
AU  - Menzies S
FAU - Leslie, Stephen J
AU  - Leslie SJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20090306
PL  - Australia
TA  - Rural Remote Health
JT  - Rural and remote health
JID - 101174860
SB  - IM
MH  - *Attitude of Health Personnel
MH  - Clinical Competence
MH  - Emergency Medical Technicians/psychology
MH  - Emergency Medicine/*methods
MH  - Evidence-Based Practice
MH  - Health Care Surveys
MH  - *Health Services Accessibility
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - Physicians, Family/*psychology
MH  - Rural Health
MH  - Scotland
MH  - *Thrombolytic Therapy
MH  - Urban Health
EDAT- 2009/03/13 09:00
MHDA- 2009/04/29 09:00
CRDT- 2009/03/13 09:00
PHST- 2009/03/13 09:00 [entrez]
PHST- 2009/03/13 09:00 [pubmed]
PHST- 2009/04/29 09:00 [medline]
AID - 1100 [pii]
PST - ppublish
SO  - Rural Remote Health. 2009 Jan-Mar;9(1):1100. Epub 2009 Mar 6.