Mercuri Mathew, Connolly Katherine, Natarajan Madhu K, Welsford Michelle, Schwalm J D
Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada.
Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada.
J Eval Clin Pract. 2018 Apr;24(2):375-379. doi: 10.1111/jep.12858. Epub 2017 Dec 13.
RATIONALE, AIMS, AND OBJECTIVES: Access to timely ST-elevation myocardial infarction (STEMI) care is facilitated by paramedics and emergency medical services (EMS). However, a large proportion of STEMI patients do not access care through EMS. This study sought to identify patient-reported factors for their decision to use (or not use) EMS.
Semi-structured interviews were conducted with a sample of STEMI patients admitted to a large tertiary care centre between November 2011 and January 2012. Participants were grouped according to mode of transportation to hospital at time of index event (EMS vs self-transport). Participant responses were classified using a published framework (modified for a STEMI population) as barriers or facilitators to EMS use, and compared between groups.
Data were collected on 61 patients (32 EMS, 29 self-transport). Mean age was 60.3 (SD 11.5), and 23% were female. EMS users were more likely to have a Killip Class >1 (25% vs 4%; P = 0.03). Self-transport patients were more likely to perceive EMS as slower (48% vs 0%) and express concerns over resources misuse (34% vs 3%; P = 0.002), when compared to EMS patients. Patients who accessed EMS were more likely to acknowledge the benefits of EMS (44% vs 7%; P = 0.001) and were more likely to have been encouraged by a family member to call EMS (34% vs 4%; P = 0.003).
STEMI patient perceptions are a key factor in determining EMS use. Health care stakeholders should target the identified barriers to improve utilization of EMS, and develop strategies to optimize care for patients who do not access EMS.
原理、目的和目标：护理人员和紧急医疗服务（EMS）有助于及时获得ST段抬高型心肌梗死（STEMI）护理。然而，很大一部分STEMI患者并非通过EMS获得护理。本研究旨在确定患者报告的决定使用（或不使用）EMS的因素。
对2011年11月至2012年1月期间入住一家大型三级护理中心的STEMI患者样本进行了半结构化访谈。参与者根据首次发病时前往医院的交通方式（EMS与自行前往）进行分组。参与者的回答根据已发表的框架（针对STEMI人群进行了修改）分类为使用EMS的障碍或促进因素，并在组间进行比较。
收集了61例患者的数据（32例使用EMS，29例自行前往）。平均年龄为60.3岁（标准差11.5），23%为女性。使用EMS的患者更有可能Killip分级>1（25%对4%；P = 0.03）。与使用EMS的患者相比，自行前往的患者更有可能认为EMS速度较慢（48%对0%），并表达对资源滥用的担忧（34%对3%；P = 0.002）。使用EMS的患者更有可能认识到EMS的好处（44%对7%；P = 0.001），并且更有可能受到家庭成员鼓励拨打EMS（34%对4%；P = 0.003）。
STEMI患者的认知是决定是否使用EMS的关键因素。医疗保健利益相关者应针对已确定的障碍来提高EMS的利用率，并制定策略以优化未使用EMS的患者的护理。
