Taggar Jaspal S, Coleman Tim, Lewis Sarah, Jones Matthew
Division of Primary Care, University of Nottingham, Nottingham, United Kingdom.
Division of Epidemiology & Public Health, University of Nottingham, Nottingham, United Kingdom.
PLoS One. 2016 Apr 1;11(4):e0152086. doi: 10.1371/journal.pone.0152086. eCollection 2016.
Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting.
A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis.
At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8-20.0); HCAs: 37.0% (21.7-55.5); nurses: 44.0% (30.0-59.0); NPs 41.2% (21.9-63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator.
Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care.
在基层医疗中进行房颤（AF）筛查已获推荐；然而，医疗保健专业人员（HCPs）的看法尚不清楚。本研究旨在确定HCPs对在基层医疗环境中开展筛查可行性的意见。
2014年10月至12月期间，对来自英国诺丁汉59家市中心诊所的418名HCPs进行了一项横断面混合方法普查。通过邮寄和网络调查，使用李克特量表和开放式问题确定有关房颤筛查的现有方法、知识、技能、态度、障碍和促进因素的数据。根据HCP组进行分类的回答，使用比例进行汇总，并对诊所聚类进行调整，给出95%置信区间，对自由文本回答采用主题分析。
48家（81%）诊所至少有一名全科医生（GP）做出回应。共有212/418（51%）名受访者；118/229名GP、67/129名护士[50名执业护士；17名执业护师（NPs）]、27/60名医疗助理（HCAs）。39/48（81%）家诊所拥有心电图机并能在内部诊断房颤。非GP的HCPs报告称，他们在心电图解读、房颤诊断和治疗方面的知识不如GP。与GP相比，更大比例的非GP的HCPs报告称，他们将从专门针对房颤诊断的心电图培训中受益[比例（95%置信区间）：GP为11.9%（6.8 - 20.0）；HCA为37.0%（21.7 - 55.5）；护士为44.0%（30.0 - 59.0）；NPs为41.2%（21.9 - 63.7）]。障碍包括进行筛查活动的时间、工作量和能力，不过诊断和管理房颤的培训是必要的促进因素。
发现市中心的普通诊所具备足够的房颤筛查资源。非GP的HCPs有提升房颤诊断和管理技能的热情，他们可能在未来的房颤筛查中发挥作用。然而，要在基层医疗中切实可行地实施房颤筛查，应克服诸如时间、人员和能力不足等组织障碍。
