Melniker L A, Leo P J
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn 11215-9008, USA.
Chest. 1998 Feb;113(2):297-305. doi: 10.1378/chest.113.2.297.
This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners.
Debate surrounding the respective roles of emergency physicians, primary care practitioners, and specialists figures prominently in discussions regarding the nation's evolving health-care system. Data are lacking about the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding conditions commonly treated by all three groups, eg, AMI.
A survey of 1,045 emergency physicians, nationally, was conducted in 1995 regarding five short-term pharmacologic interventions employed for many years in the standard treatment of AMI. The emergency physicians were questioned about the effect on survival of each intervention and the likelihood that they would prescribe each intervention. The findings were then compared with previously published data on the knowledge and practice of cardiologists and primary care practitioners obtained in New York and Texas in 1993. Identical clinical queries and eligibility criteria were employed in all groups.
The responding emergency physicians' knowledge was similar or significantly greater than that of responding cardiologists for the effect on survival of most of the short-term interventions, and their practice patterns were similar or significantly better than responding cardiologists for all interventions studied. Emergency physicians and cardiologists had significantly better knowledge and practice in this area compared with responding primary care practitioners.
For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.
本研究评估急诊医生对急性心肌梗死（AMI）治疗的知识和实践，并将结果与先前发表的关于心脏病专家和初级保健医生的数据进行比较。
围绕急诊医生、初级保健医生和专科医生各自角色的争论在关于国家不断发展的医疗保健系统的讨论中占据显著地位。目前缺乏关于急诊医生、心脏病专家和初级保健医生在这三组都常治疗的病症（如AMI）方面的比较知识和实践的数据。
1995年对全国1045名急诊医生进行了一项调查，内容涉及AMI标准治疗中多年来使用的五种短期药物干预措施。询问急诊医生每种干预措施对生存率的影响以及他们开具每种干预措施的可能性。然后将结果与1993年在纽约和德克萨斯州获得的关于心脏病专家和初级保健医生的知识和实践的先前发表的数据进行比较。所有组均采用相同的临床问题和入选标准。
对于大多数短期干预措施对生存率的影响，做出回应的急诊医生的知识与做出回应的心脏病专家相似或显著更丰富，并且在所有研究的干预措施方面，他们的实践模式与做出回应的心脏病专家相似或显著更好。与做出回应的初级保健医生相比，急诊医生和心脏病专家在该领域的知识和实践明显更好。
对于AMI的管理，与心脏病专家相比，急诊医生平均而言对大多数急性药物干预措施的生存影响有相似或更高的认识，并且在实践模式方面相似或更好；与初级保健医生相比，两组平均而言都有更卓越的知识和实践。这些结果说明了急诊医学的重要性，并支持进一步考虑急诊医生在国家不断发展的医疗保健系统中扩大作用。
