Uittenbogaart Steven B, Becker Stéphanie Je, Hoogsteyns Maartje, van Weert Henk Cpm, Lucassen Wim Am
Amsterdam University Medical Centers, University of Amsterdam Department of General Practice, Amsterdam, The Netherlands
Amsterdam University Medical Centers, University of Amsterdam Department of General Practice, Amsterdam, The Netherlands.
BJGP Open. 2022 Mar 22;6(1). doi: 10.3399/BJGPO.2021.0126. Print 2022 Mar.
Guidelines recommend screening for atrial fibrillation (AF). Currently, screening is not considered standard care among GPs.
To explore the experiences of primary care workers with different methods of screening for AF and with implementation in daily practice.
DESIGN & SETTING: A qualitative study using semi-structured interviews with GPs, nurses, and healthcare assistants (HCAs) who were experienced with implementing different methods of screening.
Two independent researchers audio-recorded and analysed interviews using a thematic approach. They asked participants about their experiences with the different methods used for screening AF and which obstacles they faced when implementing screening in daily practice.
In total 15 GPs, nurse practitioners, and HCAs from seven different practices were interviewed. The GP's office is suited for screening for AF, which ideally should be integrated with standard care. Participants considered pulse palpation, automated sphygmomanometer with AF detection, and single-lead electrocardiography (ECG) as practical tests. Participants trusted pulse palpation over the algorithm of the devices. The follow-up of a positive test with a time-consuming 12-lead ECG hindered integration of screening. The single-lead ECG device reduced the need for immediate follow-up because it can record a rhythm strip. The extra workload of screening and lack of financial coverage form obstacles for implementation.
Pulse palpation, automated blood pressure measure monitors with AF detection, and single-lead ECGs might facilitate screening in a general practice setting. When implementing screening, focus should be on how to avoid disruption of consultation hours by unplanned 12-lead ECGs.
指南建议对房颤（AF）进行筛查。目前，全科医生（GP）并未将筛查视为标准治疗。
探讨基层医疗工作者在采用不同房颤筛查方法及在日常实践中实施筛查方面的经验。
一项定性研究，采用半结构式访谈全科医生、护士和医疗保健助理（HCA），他们在实施不同筛查方法方面具有经验。
两名独立研究人员使用主题分析法对访谈进行录音和分析。他们询问参与者关于用于房颤筛查的不同方法的经验，以及在日常实践中实施筛查时面临的障碍。
总共对来自七个不同医疗机构的15名全科医生、执业护士和医疗保健助理进行了访谈。全科医生办公室适合进行房颤筛查，理想情况下应与标准治疗相结合。参与者认为脉搏触诊、带有房颤检测功能的自动血压计和单导联心电图（ECG）是实用的检测方法。参与者更信任脉搏触诊而非设备的算法。耗时的12导联心电图对阳性检测结果的后续跟进阻碍了筛查的整合。单导联心电图设备减少了立即跟进的需求，因为它可以记录心律条。筛查带来的额外工作量和缺乏资金覆盖构成了实施的障碍。
脉搏触诊、带有房颤检测功能的自动血压测量仪和单导联心电图可能有助于在全科医疗环境中进行筛查。在实施筛查时，应关注如何避免因计划外的12导联心电图而中断诊疗时间。
