Healthcare in transition in the Republic of Armenia: A longitudinal mixed-method study of emergency medical systems

Abstract

Background Acute life-threatening illness such as trauma, myocardial infarction, and stroke depend on timely recognition and treatment. There is a shift in interest by international agencies and funders in recent years towards the development of emergency care systems (EMS) in low and middle-income countries. Armenia, ex-Soviet Republic in transition since independence in 1991, has made remarkable progress but the healthcare sector, emergency systems development and education have lagged behind the overall development of the nation.Methods This manuscript describes a mixed method study used to derive a comprehensive picture of the state of EMS in Armenia. The quantitative component consists of a survey administered at three intervals over a 5-year period in 2005, 2009 and 2010 to gauge issues with the emergency medical system (EMS). A qualitative assessment of EMS was also performed using focus groups discussion and in-depth interviews.Results The quantitative questionnaire showed a positive trend in trust placed in EMS via the results of two questions “the ambulance team will respond in a timely manner”, and “the ambulance dispatcher will not request payment for services before deciding to respond to the call” (p = 0.04). These positive changes led to a statistically significant systematic increase in the percent of people who will decide to wait for the ambulance rather than to take the patient directly to the hospital in a medical emergency (p = 0.01). In-depth interviews and focus group discussions identified issues with training, timeliness of care and shortages of medications and equipment.Conclusion Nations and communities rely on emergency medical systems to care for conditions that require timely and skilled interventions. There are vital problems with emergency medical systems in Armenia related to both confidence in emergency systems from the public and physicians especially related to timeliness of care provided, training, equipment and medications. Emergency care systems development provides a comprehensive way to efficiently address multiple critical conditions. Armenia benefits from an organized emergency system as well as from the Franco-German model of care with physicians deployed in the field. An investment in training as well as critical medications and updated equipment will be key to improvement in services.