Ranasinghe Isuru, Turnbull Fiona, Tonkin Andrew, Clark Robyn A, Coffee Neil, Brieger David
George Institute for Global Health, Sydney, Australia.
Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):429-36. doi: 10.1161/CIRCOUTCOMES.112.965111. Epub 2012 May 29.
Improving timely access to reperfusion is a major goal of ST-segment-elevation myocardial infarction care. We sought to compare the population impact of interventions proposed to improve timely access to reperfusion therapy in Australia.
Australian hospitals, population, and road network data were integrated using Geographical Information Systems. Hospitals were classified into those that provided primary percutaneous coronary intervention (PPCI) or fibrinolysis. Population impact of interventions proposed to improve timely access to reperfusion (PPCI, fibrinolysis, or both) were modeled and compared. Timely access to reperfusion was defined as the proportion of the population capable of reaching a fibrinolysis facility ≤60 minutes or a PPCI facility ≤120 minutes from emergency medical services activation. The majority (93.2%) of the Australian population has timely access to reperfusion, mainly (53%) through fibrinolysis. Only 40.2% of the population had timely access to PPCI, and access to PPCI services is particularly limited in regional and nonexistent in remote areas. Optimizing the emergency medical services' response or increasing PPCI services resulted in marginal improvement in timely access (1.8% and 3.7%, respectively). Direct transport to PPCI facilities and interhospital transfer for PPCI improves timely access to PPCI for 19.4% and 23.5% of the population, respectively. Prehospital fibrinolysis markedly improved access to timely reperfusion in regional and remote Australia.
Significant gaps in timely provision of reperfusion remain in Australia. Systematic implementation of changes in service delivery has potential to improve timely access to PPCI for a majority of the population and improve access to fibrinolysis to those living in regional and remote areas.
改善再灌注治疗的及时可及性是ST段抬高型心肌梗死治疗的主要目标。我们旨在比较澳大利亚为改善再灌注治疗及时可及性而提出的干预措施对人群的影响。
利用地理信息系统整合澳大利亚医院、人口和道路网络数据。医院被分为提供直接经皮冠状动脉介入治疗（PPCI）或溶栓治疗的医院。对为改善再灌注治疗及时可及性（PPCI、溶栓治疗或两者）而提出的干预措施对人群的影响进行建模并比较。再灌注治疗的及时可及性定义为从紧急医疗服务启动后，能够在≤60分钟内到达溶栓治疗机构或≤120分钟内到达PPCI治疗机构的人群比例。澳大利亚大多数（93.2%）人口能够及时接受再灌注治疗，主要（53%）通过溶栓治疗。只有40.2%的人口能够及时接受PPCI治疗，并且PPCI服务在地区的可及性特别有限，在偏远地区则不存在。优化紧急医疗服务响应或增加PPCI服务导致及时可及性的改善幅度较小（分别为1.8%和3.7%）。直接转运至PPCI治疗机构和医院间转运接受PPCI治疗分别使19.4%和23.5%的人口能够及时接受PPCI治疗。院前溶栓显著改善了澳大利亚地区和偏远地区及时接受再灌注治疗的可及性。
澳大利亚在再灌注治疗的及时提供方面仍存在显著差距。系统实施服务提供方面的变革有可能改善大多数人口及时接受PPCI治疗的可及性，并改善居住在地区和偏远地区人群接受溶栓治疗的可及性。
