The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Heart. 2020 Oct;106(19):1477-1482. doi: 10.1136/heartjnl-2020-316621. Epub 2020 Jun 24.
This study aims to understand the current ST elevated myocardial infarction (STEMI) treatment process in Guangdong Province and explore patient-level and system-level barriers associated with delay in STEMI treatment, so as to provide recommendations for improvement.
This is a qualitative study. Data were collected using semistructured, face-to-face individual interviews from April 2018 to January 2019. Participants included patients with STEMI, cardiologists and nurses from hospitals, emergency department doctors, primary healthcare providers, local health governors, and coordinators at the emergency medical system (EMS). An inductive thematic analysis was adopted to generate overarching themes and subthemes for potential causes of STEMI treatment delay. The WHO framework for people-centred integrated health services was used to frame recommendations for improving the health system.
Thirty-two participants were interviewed. Patient-level barriers included poor knowledge in recognising STEMI symptoms and not calling EMS when symptoms occurred. Limited capacity of health professionals in hospitals below the tertiary level and lack of coordination between hospitals of different levels were identified as the main system-level barriers. Five recommendations were provided: (1) enhance public health education; (2) strengthen primary healthcare workforce; (3) increase EMS capacity; (4) establish an integrated care model; and (5) harness government's responsibilities.
Barriers associated with delay in STEMI treatment were identified at both patient and system levels. The results of this study provide a useful evidence base for future intervention development to improve the quality of STEMI treatment and patient outcomes in China and other countries in a similar situation.
本研究旨在了解广东省目前 ST 段抬高型心肌梗死（STEMI）的治疗流程，并探讨与 STEMI 治疗延迟相关的患者层面和系统层面的障碍，为改进提供建议。
这是一项定性研究。2018 年 4 月至 2019 年 1 月，采用半结构式、面对面的个人访谈收集数据。参与者包括 STEMI 患者、医院的心脏病专家和护士、急诊科医生、基层医疗服务提供者、当地卫生主管和紧急医疗服务（EMS）协调员。采用归纳主题分析生成潜在 STEMI 治疗延迟原因的总主题和子主题。采用世界卫生组织以人为本的综合卫生服务框架来构建改善卫生系统的建议。
共对 32 名参与者进行了访谈。患者层面的障碍包括对 STEMI 症状的认识不足，症状出现时不拨打 EMS。发现医院三级以下水平的卫生专业人员能力有限，以及不同级别医院之间缺乏协调是主要的系统层面障碍。提出了五条建议：（1）加强公众健康教育；（2）加强基层医疗服务人员队伍；（3）增加 EMS 能力；（4）建立综合护理模式；（5）利用政府的责任。
在患者和系统层面都确定了与 STEMI 治疗延迟相关的障碍。本研究的结果为未来干预措施的发展提供了有用的证据基础，以提高中国和其他类似情况国家 STEMI 治疗的质量和患者结局。
