Kurobe Masaya, Yamanaka Yosuke, Uda Akihito, Mori Katsuya, Akiyama Takeshi, Morishita Ayumi, Ishikawa Yuta, Watanabe Louis P, Ikeda Satoshi, Maemura Koji
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan.
HEOR Group, Value and Access Division, Novartis Pharma K.K. Tokyo Japan.
Circ Rep. 2024 Nov 15;6(12):555-563. doi: 10.1253/circrep.CR-24-0124. eCollection 2024 Dec 10.
The Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) is a regional pathway that aims to standardize practices related to the treatment of acute myocardial infarction in order to improve patient prognoses. This study aimed to understand physician backgrounds and concerns regarding implementation of the NASP.
This exploratory sequential mixed-methods study was developed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Following focus group interviews, the web-based, self-administered questionnaire survey with a cross-sectional study design was given to 62 physicians who practiced at acute care hospitals (ACHs), primary care hospitals (PCHs), or outpatient clinics (OCs) in the Nagasaki prefecture. Hayashi's quantitative theory type II analysis was used to assess the quantitative relationship between physician characteristics and their concerns. In addition, physicians were clustered based on the types of concerns they had. Our results demonstrated that specialists in cardiovascular disease held more concerns regarding implementation of the NASP. Furthermore, workload burden was found to be the most common concern among these physicians. Cooperation between physicians at ACHs and physicians at PCHs/OCs was also found to be vital for the NASP.
Interventions such as modifications to the NASP operation may assist in alleviating concerns regarding the NASP and allow for the development of tailored interventions and effective expansion of the pathway.
长崎急性心肌梗死二级预防临床路径（NASP）是一项区域路径，旨在规范与急性心肌梗死治疗相关的实践，以改善患者预后。本研究旨在了解医生关于NASP实施的背景和担忧。
本探索性序贯混合方法研究围绕RE-AIM（覆盖、效果、采用、实施和维持）框架开展。在焦点小组访谈之后，对长崎县急症医院（ACHs）、基层医疗医院（PCHs）或门诊诊所（OCs）的62名医生进行了基于网络的自填式问卷调查，采用横断面研究设计。使用林氏定量理论II型分析来评估医生特征与其担忧之间的定量关系。此外，根据医生的担忧类型对他们进行了聚类。我们的结果表明，心血管疾病专家对NASP的实施更为担忧。此外，工作量负担是这些医生中最常见的担忧。还发现ACHs的医生与PCHs/OCs的医生之间的合作对NASP至关重要。
对NASP操作进行修改等干预措施可能有助于减轻对NASP的担忧，并有助于制定针对性的干预措施以及有效地推广该路径。
