Gaspoz J M, Lovis C, Green Y, Héliot C, Mischler S, Séchaud L, Unger P F
Clinique de Médecine II, Department of Medicine, Hôpital Cantonal Universitaire, Geneva, Switzerland.
Am J Cardiol. 1998 Jun 15;81(12):1433-8. doi: 10.1016/s0002-9149(98)00202-1.
The goals of this study were to analyze the impact of a public campaign on chest pain on physicians involved in the prehospital care of patients with this symptom, in terms of physician delay, rates of immediate hospitalization, and of transportation by ambulance. Prehospital delays and decisions for all 866 patients with chest pain managed by the community and generalist physicians or by emergency physicians, who presented to the emergency department of a teaching hospital during the 12 months of the campaign, were compared with those of all 749 patients with similar presentations during the 12 months before it. When community and generalist physicians were involved, median (110 minutes) physician delay did not decrease during the campaign, whereas it decreased from 65 to 56 minutes (p <0.003) when emergency physicians were involved. Rates of immediate hospitalization (73%) and of transportation by ambulance (47%) of patients managed by community and generalist physicians were unaffected by the campaign, whereas they increased from 96% and 89%, respectively, to 98% (p = 0.09) and 94% (p <0.02) when emergency physicians were involved. Similar observations were made in patients with confirmed acute myocardial infarction and unstable angina and remained highly significant after adjustment for differences in clinical characteristics. Thus, community and generalist physicians did not significantly modify their prehospital management of patients with chest pain despite a public campaign. To be successful, guidelines on the matter have to be developed with the active participation of these physicians.
本研究的目的是分析一场胸痛宣传活动对参与此类症状患者院前护理的医生的影响，具体涉及医生延误、立即住院率和救护车转运率。将活动开展的12个月期间，由社区医生、全科医生或急诊科医生在一家教学医院急诊科处理的所有866例胸痛患者的院前延误和决策，与活动开展前12个月期间所有749例有类似症状患者的情况进行比较。当社区医生和全科医生参与时，活动期间医生的中位延误时间（110分钟）没有减少，而当急诊科医生参与时，中位延误时间从65分钟降至56分钟（p<0.003）。由社区医生和全科医生处理的患者的立即住院率（73%）和救护车转运率（47%）不受活动影响，而当急诊科医生参与时，立即住院率分别从96%和89%升至98%（p = 0.09）和94%（p<0.02）。在确诊为急性心肌梗死和不稳定型心绞痛的患者中也观察到了类似情况，在对临床特征差异进行调整后，这些差异仍然非常显著。因此，尽管开展了一场宣传活动，社区医生和全科医生对胸痛患者的院前管理并没有显著改变。要取得成功，必须在这些医生的积极参与下制定相关指南。
