Rawles J
Medicines Assessment Research Unit, University of Aberdeen.
BMJ. 1994 Aug 6;309(6951):379-82. doi: 10.1136/bmj.309.6951.379.
To investigate reasons for general practitioners not giving thrombolytic treatment to eligible patients with acute myocardial infarction.
Postal questionnaires were sent to 424 general practitioners.
97 general practitioners who had taken part in the Grampian region early anistreplase trial, 185 whose practices in Scotland were at least 24 km from a district general hospital, and 142 who had attended postgraduate conferences at which thrombolysis had been discussed; 87, 158, and 125 respectively responded.
Answers to questions about readiness to use thrombolytic treatment.
Response rate was 87% (370/424). Almost all respondents (350) were convinced of benefits of thrombolysis for acute myocardial infarction, and 277 were convinced that there were additional benefits from its administration in the community at first opportunity. Most doctors working 16 km or more from hospital thought that giving treatment at home would appreciably save time (200/274). Most doctors agreed that they could make time to give thrombolytic treatment (278), and would be willing to record an electrocardiogram (284), and would be able to interpret it (280). Sixty four respondents (17%) reported using thrombolytic treatment in previous year. Among non-users, 150 (49%) were unwilling to use thrombolytic treatment without further training. While many non-users (210 (69%)) were willing to use thrombolytic treatment without encouragement from Department of Health, 184 (60%) were unwilling to use it unless encouraged to do so by their local cardiologist.
The need to become better informed about thrombolysis and lack of encouragement from local cardiologists were important factors preventing wider use of thrombolytic treatment in the community by general practitioners.
调查全科医生不给符合条件的急性心肌梗死患者进行溶栓治疗的原因。
向424名全科医生发送邮政调查问卷。
97名参与格兰扁地区早期阿尼普酶试验的全科医生、185名在苏格兰其诊所距离地区综合医院至少24公里的全科医生以及142名参加过讨论溶栓治疗的研究生会议的全科医生;分别有87名、158名和125名做出回应。
关于使用溶栓治疗意愿问题的答案。
回复率为87%(370/424)。几乎所有受访者(350名)都确信溶栓治疗对急性心肌梗死有益,277名受访者确信在社区尽早进行溶栓治疗还有额外益处。大多数在距离医院16公里或更远地方工作的医生认为在家中进行治疗能显著节省时间(200/274)。大多数医生同意他们能抽出时间进行溶栓治疗(278名),愿意记录心电图(284名),并且能够解读心电图(280名)。64名受访者(17%)报告上一年使用过溶栓治疗。在未使用者中,150名(49%)不愿意在没有进一步培训的情况下使用溶栓治疗。虽然许多未使用者(210名(69%))愿意在没有卫生部鼓励的情况下使用溶栓治疗,但184名(60%)不愿意使用,除非得到当地心脏病专家的鼓励。
需要更好地了解溶栓治疗以及缺乏当地心脏病专家的鼓励是阻碍全科医生在社区更广泛使用溶栓治疗的重要因素。