Harsanyi Szilvia, Balogh Nandor, Kolozsvari Laszlo Robert, Mezes Laszlo, Papp Csaba, Zsuga Judit
Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
University of Debrecen, Doctoral School of Health Sciences, Debrecen, Hungary.
Health Res Policy Syst. 2020 Oct 31;18(1):128. doi: 10.1186/s12961-020-00642-5.
Translating clinical guidelines into routine clinical practice is mandatory to achieve population level improvement of health. Emergence of specific therapy for acute stroke yielded the 'time is brain' concept introducing the need for emergency treatment, pointing to the need for increasing stroke awareness of the general population. General practitioners (GPs) manage chronic diseases and could hence catalyse stroke awareness. In our study, the knowledge of general practitioners toward accurate identification of acute stroke candidacy was investigated.
GPs and residents in training for family medicine participated in a survey on a voluntary basis using supervised self-administration between the 1st of February 2018 and 31st July 2018. Two clinical cases of acute stroke that differed only regarding the patient's eligibility for intravenous thrombolysis were presented. Participants answered two open-ended questions. Text analysis was performed using NVIVO software.
Of the 127 respondents, 69 (54.3%) were female. The median age was 49 (34-62) years. The median time spent working after graduation was 14.5 (2-22.5) years. Board-certified GPs made up 77.2% of the sample. Qualitative analysis revealed stroke as the most frequent diagnosis for both cases. Territorial localization and possible aetiology were also established. Respondents properly identified eligibility for thrombolysis. Quantitative assessment showed that having the practice closer to the stroke centre increases the likelihood of adequate diagnosis for acute stroke.
Our results show that GPs properly diagnose acute stroke and identify intravenous thrombolysis candidates. Moreover, we found that a vigorous acute stroke triage system facilitates the translation of theory into practice.
将临床指南转化为常规临床实践对于实现人群健康水平的提升至关重要。急性中风特异性治疗方法的出现产生了“时间就是大脑”的概念，引入了紧急治疗的必要性，这表明需要提高普通人群对中风的认识。全科医生（GPs）负责管理慢性病，因此可以促进中风意识的提高。在我们的研究中，调查了全科医生对准确识别急性中风候选者的知识掌握情况。
2018年2月1日至2018年7月31日期间，全科医生和家庭医学培训住院医师自愿参与了一项使用监督式自我管理的调查。呈现了两个仅在患者静脉溶栓资格方面存在差异的急性中风临床病例。参与者回答了两个开放式问题。使用NVIVO软件进行文本分析。
在127名受访者中，69名（54.3%）为女性。年龄中位数为49（34 - 62）岁。毕业后工作的时间中位数为14.5（2 - 22.5）年。获得委员会认证的全科医生占样本的77.2%。定性分析显示中风是两个病例中最常见的诊断。还确定了区域定位和可能的病因。受访者正确识别了溶栓资格。定量评估表明，诊所距离中风中心更近会增加对急性中风进行充分诊断的可能性。
我们的结果表明，全科医生能够正确诊断急性中风并识别静脉溶栓候选者。此外，我们发现一个有力的急性中风分诊系统有助于将理论转化为实践。
