Effect of a Community Intervention on Patient Delay and Emergency Medical Service Use in Acute Coronary Heart Disease

Luepker, Russell V.; Raczynski, James M.; Osganian, Stavroula K.; Goldberg, Robert J.; Finnegan, John R.; Hedges, Jerris R.; Goff, David C.; Eisenberg, Mickey S.; Zapka, Jane G.; Feldman, Henry A.; Labarthe, Darwin R.; McGovern, Paul G.; Cornell, Carol E.; Proschan, Michael A.; Simons‐Morton, Denise G.

doi:10.1001/jama.284.1.60

Cited by 466 publications

(369 citation statements)

References 31 publications

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“…Postcampaign EMS utilization rates were significantly greater than precampaign rates. 18 Luepker et al 19 and Wright et al 20 also have shown increased ambulance use after a general media campaign was carried out. Patients need to understand that they should never attempt to drive themselves, or even let somebody else drive them to hospital, if they think they are having MI symptoms.…”

Section: Discussionmentioning

confidence: 98%

Use of Emergency Medical Services in Patients with Acute Myocardial Infarction in China

Zhang

Wang

et al. 2009

Clinical Cardiology

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Background: Although guidelines strongly recommend use of the Emergency Medical Systems (EMS) by patients with acute myocardial infarction (AMI), it remains underutilized in western countries. Information about its current use in China is unclear. The objective of this study was to examine the use of the EMS by patients with AMI in China, and investigate factors affecting its use. Methods: A prospective survey study, which included 803 patients with AMI who were admitted to 21 hospitals in China between November 1, 2005 and December 31, 2006. Results: Only 39.5% of patients called up the EMS at the onset of symptoms (EMS group, n = 317), whereas the rest presented to the hospital by some other means (self-transport group, n = 486, 60.5%). Predictors of EMS users were older age, symptom onset at evening, unbearable symptoms, having received training and acquired knowledge on heart attack, as well as having a higher income and medical history of heart failure or stroke. Prehospital delay (median 110 min vs. 143 min, p < 0.001), door to needle time (median 85 min vs. 93 min, p < 0.005) and door-to-balloon time (median 118 min vs. 160 min, p < 0.001) were significantly shorter in the EMS group. The early reperfusion rate was also significantly higher in the EMS group (84.8% vs. 78.2%, p = 0.019), mainly because of a greater incidence of primary percutaneous coronary intervention (68.1% vs. 61.7%, p = 0.046). Conclusions:The emergency medical services are underutilized by patients with AMI in China. Use of the EMS may be advantageous in view of greater administration of reperfusion therapy. New public health strategies should be developed to facilitate greater use of the EMS for AMI.

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Section: Discussionmentioning

confidence: 98%

Use of Emergency Medical Services in Patients with Acute Myocardial Infarction in China

Zhang

Wang

et al. 2009

Clinical Cardiology

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“…37 In the USA, mass media promotion about acute myocardial infarction increased emergency ambulance usage, 38 whereas in Canada, an increase in stroke presentations to EDs followed a stroke awareness media campaign. 39 Although ambulance use was not measured, this would be expected to increase concomitantly.…”

Section: Increased Health Awarenessmentioning

confidence: 99%

Increasing utilisation of emergency ambulances

Lowthian¹,

Cameron²,

Stoelwinder³

et al. 2011

Aust. Health Review

170

148

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Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied.Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase.Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed.Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.

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“…Despite an intense public education campaign over 18 months, the time from symptom onset to hospital presentation remained unaltered in patients with ischemic symptoms. 17 Hence, a substantial further reduction in time to treatment is likely best achieved by enhancing prehospital diagnosis and therapy rather than by expecting patients to seek medical attention earlier. 18 …”

Section: Evolution Of Pharmacological Reperfusion Regimensmentioning

confidence: 99%