1
|
Baradi A, Dinh DT, Brennan A, Stub D, Somaratne J, Palmer S, Nehme Z, Andrew E, Smith K, Liew D, Reid CM, Lefkovits J, Wilson A. Prevalence and Predictors of Emergency Medical Service Use in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction. Heart Lung Circ 2024; 33:990-997. [PMID: 38570261 DOI: 10.1016/j.hlc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024]
Abstract
AIM We aim to describe prevalence of Emergency Medical Service (EMS) use, investigate factors predictive of EMS use, and determine if EMS use predicts treatment delay and mortality in our ST-elevation myocardial infarction (STEMI) cohort. METHOD We prospectively collected data on 5,602 patients presenting with STEMI for primary percutaneous coronary intervention (PCI) transported to PCI-capable hospitals in Victoria, Australia, from 2013-2018 who were entered into the Victorian Cardiac Outcomes Registry (VCOR). We linked this dataset to the Ambulance Victoria and National Death Index (NDI) datasets. We excluded late presentation, thrombolysed, and in-hospital STEMI, as well as patients presenting with cardiogenic shock and out-of-hospital cardiac arrest. RESULTS In total, 74% of patients undergoing primary PCI for STEMI used EMS. Older age, female gender, higher socioeconomic status, and a history of prior ischaemic heart disease were independent predictors of using EMS. EMS use was associated with shorter adjusted door-to-balloon (53 vs 72 minutes, p<0.001) and symptom-to-balloon (183 vs 212 minutes, p<0.001) times. Mode of transport was not predictive of 30-day or 12-month mortality. CONCLUSIONS EMS use in Victoria is relatively high compared with internationally reported data. EMS use reduces treatment delay. Predictors of EMS use in our cohort are consistent with those prevalent in prior literature. Understanding the patients who are less likely to use EMS might inform more targeted education campaigns in the future.
Collapse
Affiliation(s)
- Arul Baradi
- Cambridge Cardiovascular Epidemiology Unit, Cambridge University, Cambridgeshire, United Kingdom; Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia.
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Jithendra Somaratne
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand; Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Sonny Palmer
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Andrew Wilson
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia
| |
Collapse
|
2
|
Ratwatte S, Ng ACC, Hyun K, Philip R, Boroumand F, Weber C, Kritharides L, Brieger D. Pre-hospital and in-hospital ST-elevation myocardial infarction from 2008 to 2020 in Australia. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200214. [PMID: 37771608 PMCID: PMC10522901 DOI: 10.1016/j.ijcrp.2023.200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - Robin Philip
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - Farzaneh Boroumand
- School of Mathematical and Physical Sciences, Macquarie University, NSW, Australia
| | - Courtney Weber
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, NSW, Australia
| |
Collapse
|
3
|
Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, Bowen S, Regan E, Lander M, van Berlo S, Freene N. Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e48229. [PMID: 37788043 PMCID: PMC10582808 DOI: 10.2196/48229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. OBJECTIVE We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. METHODS A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. CONCLUSIONS The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-040479.
Collapse
Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Bowen
- National Capital Private Hospital, Garran, ACT, Australia
| | | | | | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| |
Collapse
|
4
|
Nehme Z, Cameron P, Nehme E, Finn J, Bosley E, Brink D, Ball S, Doan TN, Bray JE. Effect of a national awareness campaign on ambulance attendances for chest pain and out-of-hospital cardiac arrest. Resuscitation 2023; 191:109932. [PMID: 37562665 DOI: 10.1016/j.resuscitation.2023.109932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
AIM Awareness of heart attack symptoms may enhance health-seeking behaviour and prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of a national awareness campaign on emergency medical service (EMS) attendances for chest pain and OHCA. METHODS Between January 2005 and December 2017, we included registry data for 97,860 EMS-attended OHCA cases from 3 Australian regions and dispatch data for 1,631,217 EMS attendances for chest pain across 5 Australian regions. Regions were exposed to between 11 and 28 months of television, radio, and print media activity. Multivariable negative binomial models were used to explore the effect of campaign activity on the monthly incidence of EMS attendances for chest pain and OHCA. RESULTS Months with campaign activity were associated with an 8.8% (IRR 1.09, 95% CI: 1.07, 1.11) increase in the incidence of EMS attendances for chest pain and a 5.6% (IRR 0.94, 95% CI: 0.92, 0.97) reduction in OHCA attendances. Larger intervention effects were associated with increasing months of campaign activity, increasing monthly media spending and media exposure in 2013. In stratified analyses of OHCA cases, the largest reduction in incidence during campaign months was observed for unwitnessed arrests (IRR 0.93, 95% CI: 0.90, 0.96), initial non-shockable arrests (IRR 0.93, 95% CI: 0.90, 0.97) and arrests occurring in private residences (IRR 0.95, 95% CI: 0.91, 0.98). CONCLUSION A national awareness campaign targeting knowledge of heart attack symptoms was associated with an increase in EMS use for chest pain and a reduction in OHCA incidence and may serve as an effective primary prevention strategy for OHCA.
Collapse
Affiliation(s)
- Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital,Alfred Health, Prahran, Victoria, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Deon Brink
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Stephen Ball
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Tan N Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia
| |
Collapse
|
5
|
Bray JE, Nehme Z, Finn JC, Kasza J, Clark RA, Stub D, Cadilhac DA, Buttery AK, Woods J, Kim J, Smith BJ, Smith K, Cartledge S, Beauchamp A, Dodge N, Walker T, Flemming-Judge E, Chow C, Stewart M, Cox N, van Gaal W, Nadurata V, Cameron P. A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk. Resusc Plus 2023; 15:100431. [PMID: 37555197 PMCID: PMC10405322 DOI: 10.1016/j.resplu.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
AIM To describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS. METHODS The trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900). RESULTS The intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024. CONCLUSION The results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use.
Collapse
Affiliation(s)
- Janet E. Bray
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
- Alfred Health, Australia
| | - Ziad Nehme
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Ambulance Victoria, Australia
| | - Judith C. Finn
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing, Curtin University, Australia
| | - Jessica Kasza
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Robyn A. Clark
- Caring Futures Institute, Flinders University, Australia
- Southern Adelaide Local Health Network, Australia
| | - Dion Stub
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
- Ambulance Victoria, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | | | - Janelle Woods
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- National Heart Foundation of Australia, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health University of Melbourne, Australia
| | - Ben J. Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Prevention Research Collaboration, School of Public Health, University of Sydney, Australia
| | - Karen Smith
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Department of Research and Innovation, Silverchain, Australia
| | - Susie Cartledge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | | | - Natasha Dodge
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
| | - Tony Walker
- Department of Paramedicine, Monash University, Australia
| | | | - Clara Chow
- Faculty of Medicine and Health, Westmead Applied Research Centre, University of Sydney, Australia
- Westmead Hospital, Australia
| | | | | | | | | | - Peter Cameron
- Monash School of Public Health and Preventive Medicine, Monash University, Australia
- Alfred Health, Australia
| |
Collapse
|
6
|
Breuer F, Beckers SK, Dahmen J, Gnirke A, Pommerenke C, Poloczek S. [Pre-emptive emergency service-Preventive missions and promotion of health literacy at the intersections with emergency medical services]. DIE ANAESTHESIOLOGIE 2023; 72:358-368. [PMID: 36912990 PMCID: PMC10010211 DOI: 10.1007/s00101-023-01272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
In the Emergency Medical Service Acts of the Federal States, the statements in these Acts have so far essentially been limited to the implementation of measures to maintain the health of emergency patients and to transport them to a suitable hospital. Preventive fire protection, on the other hand, is regulated in the Fire Brigade Acts or by statutory ordinances. Increasing numbers of emergency service missions and a lack of facilities for alternative care justify the need for a preventive emergency service. This includes all measures that take place before an event occurs in order to prevent emergencies from occurring. As a result, the risk of an emergency event leading to the emergency call 112 should be reduced or delayed. The preventive rescue service should also help to improve the outcome of medical care for patients. Furthermore, it should be made possible to provide those seeking help with a suitable form of care at an early stage.
Collapse
Affiliation(s)
- Florian Breuer
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland.
- Ärztliche Leitung Rettungsdienst, Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469, Bergisch Gladbach, Deutschland.
| | - Stefan K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Fachbereich Feuerwehr und Rettungsdienst Stadt Aachen, Aachen, Deutschland
| | - Janosch Dahmen
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Andre Gnirke
- Ärztliche Leitung Rettungsdienst, Rettungsdienst-Kooperation in Schleswig-Holstein, Pinneberg, Deutschland
| | | | - Stefan Poloczek
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
| |
Collapse
|
7
|
Declining Public Awareness of Heart Attack Warning Symptoms in the Years Following an Australian Public Awareness Campaign: A Cross-Sectional Study. Heart Lung Circ 2023; 32:497-505. [PMID: 36801125 DOI: 10.1016/j.hlc.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The National Heart Foundation of Australia's (NHFA) Warning Signs campaign ran between 2010 and 2013. This study examines trends in Australian adults' ability to name heart attack symptoms during the campaign and in the years following. METHODS Using the NHFA's HeartWatch data (quarterly online surveys) for adults aged 30-59 years, we conducted an adjusted piecewise regression analysis comparing trends in the ability to name symptoms during the campaign period plus one year lag (2010-2014) to the post-campaign period (2015-2020) RESULTS: Over the study period, there were 101,936 Australian adults surveyed. Symptom awareness was high or increased during the campaign period. However, there was a significant downward trend in each year following the campaign period for most symptoms (e.g., chest pain: adjusted odds ratio [AOR] =0.91, 95%CI: 0.56-0.80; arm pain: AOR=0.92, 95%CI: 0.90-0.94). Conversely, the inability to name any heart attack symptom increased in each year following the campaign (3.7% in 2010 to 19.9% in 2020; AOR=1.13, 95%CI: 1.10-1.15); these respondents were more likely to be younger, male, have less than 12 years of education, identify as Aboriginal and/or Torres Strait Islander Peoples, speak a language other than English at home and have no cardiovascular risk factors. CONCLUSION Awareness of heart attack symptoms has decreased in the years since the Warning Signs campaign in Australia, with 1 in 5 adults currently unable to name a single heart attack symptom. New approaches are needed to promote and sustain this knowledge, and to ensure people act appropriately and promptly if symptoms occur.
Collapse
|
8
|
Redwood E, Hyun K, French J, Chew D, Kritharides L, Brieger D. Impact of the "Warning Signs Campaign" on Characteristics of Patients Presenting with Acute Coronary Syndrome (ACS) to Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10700. [PMID: 36078416 PMCID: PMC9517920 DOI: 10.3390/ijerph191710700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The National Heart Foundation's Warning Signs Campaign (2009-2013) aimed to raise awareness amongst the public of Acute Coronary Syndrome (ACS), encouraging people to recognise suggestive symptoms and seek immediate medical attention. This study explores the impact of the campaign on the characteristics of patients presenting to hospitals around Australia with ACS. DESIGN Retrospective cohort analysis Setting: 10 Australian Hospitals recruiting for the CONCORDANCE registry continuously throughout the campaign period. PARTICIPANTS Patients presenting with ACS to hospitals before, during and after the campaign ran in their jurisdiction. MAIN OUTCOME MEASURES Whether an ambulance was called, time between onset of symptoms to first medical contact, as well as time between onset of symptoms to primary percutaneous intervention or lysis. RESULTS Time to first medical contact did not improve during or post-campaign for NSTEACS medical hours (IQI) 1.6 (0.5-4.8) pre, 2.2 (0.7-7.6) during, 2 (0.7-6.9) post (p < 0.001) or STEMI, 1.1 (0.4-3.5) pre, 1.6 (0.6-5.1) during, 1.4 (0.5-4.3) post (p = 0.0113). In STEMI, time from symptom onset to pPCI (p = 0.256) and time to lysis (p = 0.387) were also unchanged. The proportion of ambulance arrivals remained stable (pre 55% vs. during 58%, p = 0.493). Patients presenting during the campaign were more likely to be born in Australia 56% pre, 69% during, 68% post (p < 0.001), to report English as a first language 67% pre, 84% during, 79% post (p < 0.001), and had lower likelihood of prior MI or revascularization but greater likelihood of cardiovascular risk factors compared to those presenting prior. CONCLUSION Among patients with ACS, we detected no increase in proportion of ambulance presentations nor earlier presentations among NSTEACS or STEMI during the campaign. There was an increase in the proportion of patients for whom English was the first language and those without a prior cardiac history but with cardiovascular risk factors, suggesting that the campaign impacted preferentially on certain strata in the community.
Collapse
Affiliation(s)
- Eleanor Redwood
- Department of Cardiology, Northern Beaches Hospital, Sydney, NSW 2086, Australia
| | - Karice Hyun
- School of Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, NSW 2137, Australia
| | - John French
- Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Derek Chew
- Department of Cardiology, Flinders University, Adelaide, SA 5042, Australia
| | - Leonard Kritharides
- Atherosclerosis Laboratory, ANZAC Research Institute, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW 2000, Australia
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia
| |
Collapse
|
9
|
Dawson LP, Smith K, Cullen L, Nehme Z, Lefkovits J, Taylor AJ, Stub D. Care Models for Acute Chest Pain That Improve Outcomes and Efficiency. J Am Coll Cardiol 2022; 79:2333-2348. [DOI: 10.1016/j.jacc.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
|
10
|
Wibring K, Lingman M, Herlitz J, Bång A. The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:34. [PMID: 35527302 PMCID: PMC9080130 DOI: 10.1186/s13049-022-01021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objectives
To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.
Methods
Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.
Results
Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.
Conclusions
By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.
Collapse
|
11
|
Mills BW, Hill MG, Miles AK, Smith EC, Afrifa-Yamoah E, Reid DN, Rogers SL, Sim MGB. Ability of the Australian general public to identify common emergency medical situations: Results of an online survey of a nationally representative sample. Australas Emerg Care 2022; 25:327-333. [PMID: 35525724 DOI: 10.1016/j.auec.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response. METHODS An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged >18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 40% more often compared with non-indigenous participants. CONCLUSIONS Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.
Collapse
Affiliation(s)
- Brennen W Mills
- School of Medical and Health Sciences, Edith Cowan University, Australia.
| | - Michella G Hill
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Alecka K Miles
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Erin C Smith
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | | | - David N Reid
- School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Shane L Rogers
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Moira G B Sim
- School of Medical and Health Sciences, Edith Cowan University, Australia
| |
Collapse
|
12
|
Hodgins P, McMinn M, Shah A, Reed MJ, Mercer S, Guthrie B. Unscheduled care pathways in patients with myocardial infarction in Scotland. Heart 2022; 108:1129-1136. [DOI: 10.1136/heartjnl-2021-320614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/03/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTreatment of acute myocardial infarction (MI) requires rapid transfer of people with chest pain to hospital, however, unscheduled care pathways vary in their directness (the minimal number of contacts to hospital admission). The aim was to examine unscheduled care pathways and the associations with mortality in people admitted with MI.MethodsRetrospective population study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. Linked data for all National Health Service Scotland unscheduled care services (NHS24 telephone triage service, primary care out of hours, ambulance, emergency department (ED)) was used to define continuous unscheduled care pathways (pathways), which were categorised by initial contact, and whether they were ‘direct’ (had minimum number of contacts between first contact and admission). Analysis estimated ORs and 95% CIs in adjusted models in which all covariates were included.Results26 325 people admitted with MI (63.1% men, 61.6% aged 65+ years), of whom 5.6% died from coronary heart disease within 28 days. For 47.0%, the first unscheduled care contact was ambulance, 23.3% attended ED directly and 18.7% called telephone triage. 92.1% of pathways were direct. Pathways starting with telephone triage were more likely to be indirect compared with other initial contacts (adjusted OR (aOR) 1.97, 95% CI 1.61 to 2.40). Compared to direct pathways, indirect pathways starting with telephone triage were associated with higher mortality (aOR 1.97, 95% CI 1.61 to 2.40) as were indirect pathways starting with another service (aOR 1.55, 95% CI 1.19 to 2.01), but not direct pathways starting with telephone triage (aOR 0.87, 95% CI 0.74 to 1.02).ConclusionUnscheduled care pathways leading to admission with MI in Scotland are usually direct, but those starting with telephone triage were more commonly indirect. Those indirect pathways were associated with higher mortality.
Collapse
|
13
|
Eastwood K, Howell S, Nehme Z, Finn J, Smith K, Cameron P, Stub D, Bray JE. Impact of a mass media campaign on presentations and ambulance use for acute coronary syndrome. Open Heart 2021; 8:openhrt-2021-001792. [PMID: 34663748 PMCID: PMC8524379 DOI: 10.1136/openhrt-2021-001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/23/2021] [Indexed: 11/07/2022] Open
Abstract
Objective Between 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of acute coronary syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia. Methods The Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and (1) EMS arrival and (2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics. Results Between 2003 and 2015, there were 124 632 eligible ED presentations with ACS and 536 148 with U-CP. In patients with ACS, the campaign period was associated with an increase in ED presentations (incidence rate ratio: 1.11; 95% CI 1.07 to 1.15), a decrease in presentations via a GP (adjusted OR (AOR): 0.77; 95% CI 0.70 to 0.86) and an increase in EMS use (AOR: 1.10; 95% CI 1.05 to 1.17). Similar, but smaller associations were seen in U-CP. Conclusions The Warning Signs Campaign was associated with improvements in treatment seeking in patients with ACS—including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education needs to focus on improving EMS use in ACS patient groups where use remains low.
Collapse
Affiliation(s)
- Kathryn Eastwood
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Stuart Howell
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Judith Finn
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Peter Cameron
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Janet E Bray
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia.,Emergency and Cardiology Departments, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Yin X, He Y, Zhang J, Song F, Liu J, Sun G, Liang Y, Ye J, Hu Y, Song M, Chen C, Xu Q, Tan N, Chen J, Liu Y, Liu H, Tian M. Patient-level and system-level barriers associated with treatment delays for ST elevation myocardial infarction in China. Heart 2020; 106:1477-1482. [PMID: 32580976 DOI: 10.1136/heartjnl-2020-316621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/10/2020] [Accepted: 05/17/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to understand the current ST elevated myocardial infarction (STEMI) treatment process in Guangdong Province and explore patient-level and system-level barriers associated with delay in STEMI treatment, so as to provide recommendations for improvement. METHODS This is a qualitative study. Data were collected using semistructured, face-to-face individual interviews from April 2018 to January 2019. Participants included patients with STEMI, cardiologists and nurses from hospitals, emergency department doctors, primary healthcare providers, local health governors, and coordinators at the emergency medical system (EMS). An inductive thematic analysis was adopted to generate overarching themes and subthemes for potential causes of STEMI treatment delay. The WHO framework for people-centred integrated health services was used to frame recommendations for improving the health system. RESULTS Thirty-two participants were interviewed. Patient-level barriers included poor knowledge in recognising STEMI symptoms and not calling EMS when symptoms occurred. Limited capacity of health professionals in hospitals below the tertiary level and lack of coordination between hospitals of different levels were identified as the main system-level barriers. Five recommendations were provided: (1) enhance public health education; (2) strengthen primary healthcare workforce; (3) increase EMS capacity; (4) establish an integrated care model; and (5) harness government's responsibilities. CONCLUSIONS Barriers associated with delay in STEMI treatment were identified at both patient and system levels. The results of this study provide a useful evidence base for future intervention development to improve the quality of STEMI treatment and patient outcomes in China and other countries in a similar situation.
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Zhang
- School of Public Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yunzhao Hu
- Department of Cardiology, The First People's Hospital of Shunde, Shunde, China
| | - Mingcai Song
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Cong Chen
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Qingbo Xu
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Beijing, China
| |
Collapse
|
15
|
Ambulance Services Associated with Extreme Temperatures and Fine Particles in a Subtropical Island. Sci Rep 2020; 10:2855. [PMID: 32071336 PMCID: PMC7029034 DOI: 10.1038/s41598-020-59294-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the association between the risk of events requiring ambulance services and the ambient temperature and particulate matter of 2.5 μm (PM2.5) and 10 μm (PM10) for populations living in subtropical Taiwan. We used a distributed lag nonlinear model with a quasi-Poisson function to assess the roles of ambient temperature, PM10 and PM2.5 in the use of ambulance services for respiratory distress, coma and unconsciousness, chest pain, lying down in public, headaches/dizziness/vertigo/fainting/syncope and out-of-hospital cardiac arrest (OHCA). The relative risk (RR) and 95% confidence interval (CI) of each specific event were calculated in association with the ambient conditions. In general, the events that required ambulance services had a V-shaped or J-shaped association with the temperature, where the risks were higher at extreme temperatures. The RR of each event was significant when the patients were exposed to temperatures in the 5th percentile (<15 °C); patients with OHCA had the highest adjusted RR of 1.61 (95% CI = 1.47–1.77). The risks were also significant for coma/unconsciousness, headaches/dizziness/vertigo/fainting/syncope, and OHCA but not for respiratory distress, chest pain and lying down in public, after exposure to the 99th percentile temperatures of >30 °C. The risks for use of ambulance services increased with PM exposure and were significant for events of respiratory distress, chest pain and OHCA after exposure to the 99th percentile PM2.5 after controlling for temperatures. Events requiring ambulance services were more likely to occur when the ambient temperature was low than when it was high for the population on the subtropical island of Taiwan. The association of the risk of events requiring ambulance services with PM were not as strong as the association with low temperatures.
Collapse
|
16
|
Cui ER, Beja-Glasser A, Fernandez AR, Grover JM, Mann NC, Patel MD. Emergency Medical Services Time Intervals for Acute Chest Pain in the United States, 2015–2016. PREHOSP EMERG CARE 2019; 24:557-565. [DOI: 10.1080/10903127.2019.1676346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Nehme Z, Smith K. More evidence that out-of-hospital cardiac arrest is preventable. Resuscitation 2019; 141:195-196. [PMID: 31185257 DOI: 10.1016/j.resuscitation.2019.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.
| |
Collapse
|
18
|
Riaño-Casallas MI, Tompa E. Cost-benefit analysis of investment in occupational health and safety in Colombian companies. Am J Ind Med 2018; 61:893-900. [PMID: 30284313 DOI: 10.1002/ajim.22911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether investment in preventive measures by a Colombian insurer reduces rates of work-related injuries and results in positive returns from these investments. METHODS The study is based on monthly panel data of 2011-2015 of 303 medium and large companies affiliated with a private insurer in Colombia. We undertook regression modeling analysis to assess the effectiveness of incremental investments in occupational health and safety (OHS) prevention measures. The cost-benefit analysis is from the insurer's perspective. RESULTS Investment in OHS per full-time equivalent was statistically significant at the 1% level. We estimated that 4919 injuries were averted through these investments, resulting in the avoidance of $3 949 957 in costs. Our results suggest that the investments were worth undertaking from the insurer's perspective. CONCLUSIONS This paper provides new empirical evidence on the effectiveness and cost-benefit of OHS investments in a middle-income country. Incremental investment in OHS can be effective and cost-beneficial.
Collapse
Affiliation(s)
| | - Emile Tompa
- Institute for Work & Health; Toronto Ontario Canada
- Department of Economics; McMaster University; Hamilton Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
| |
Collapse
|
19
|
Mercuri M, Connolly K, Natarajan MK, Welsford M, Schwalm JD. Barriers to the use of emergency medical services for ST-elevation myocardial infarction: Determining why many patients opt for self-transport. J Eval Clin Pract 2018; 24:375-379. [PMID: 29239074 DOI: 10.1111/jep.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Access to timely ST-elevation myocardial infarction (STEMI) care is facilitated by paramedics and emergency medical services (EMS). However, a large proportion of STEMI patients do not access care through EMS. This study sought to identify patient-reported factors for their decision to use (or not use) EMS. METHODS Semi-structured interviews were conducted with a sample of STEMI patients admitted to a large tertiary care centre between November 2011 and January 2012. Participants were grouped according to mode of transportation to hospital at time of index event (EMS vs self-transport). Participant responses were classified using a published framework (modified for a STEMI population) as barriers or facilitators to EMS use, and compared between groups. RESULTS Data were collected on 61 patients (32 EMS, 29 self-transport). Mean age was 60.3 (SD 11.5), and 23% were female. EMS users were more likely to have a Killip Class >1 (25% vs 4%; P = 0.03). Self-transport patients were more likely to perceive EMS as slower (48% vs 0%) and express concerns over resources misuse (34% vs 3%; P = 0.002), when compared to EMS patients. Patients who accessed EMS were more likely to acknowledge the benefits of EMS (44% vs 7%; P = 0.001) and were more likely to have been encouraged by a family member to call EMS (34% vs 4%; P = 0.003). CONCLUSIONS STEMI patient perceptions are a key factor in determining EMS use. Health care stakeholders should target the identified barriers to improve utilization of EMS, and develop strategies to optimize care for patients who do not access EMS.
Collapse
Affiliation(s)
- Mathew Mercuri
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Katherine Connolly
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada
| | - Madhu K Natarajan
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Michelle Welsford
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada; Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Canada
| | - J D Schwalm
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| |
Collapse
|
20
|
Nehme Z, Bernard S, Andrew E, Cameron P, Bray JE, Smith K. Warning symptoms preceding out-of-hospital cardiac arrest: Do patient delays matter? Resuscitation 2018; 123:65-70. [DOI: 10.1016/j.resuscitation.2017.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/27/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
|
21
|
Cartledge S, Finn J, Straney L, Ngu P, Stub D, Patsamanis H, Shaw J, Bray J. The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign. Emerg Med J 2017; 34:466-471. [PMID: 28289037 DOI: 10.1136/emermed-2016-206396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS. METHODS Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35-75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use. RESULTS Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting. CONCLUSION In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS.
Collapse
Affiliation(s)
- Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Phillip Ngu
- Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia.,Western Health, Victoria, Australia
| | | | - James Shaw
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
22
|
Thompson PL, Shilton T. Encouraging early treatment of suspected heart attack: it's OK to call 000. Med J Aust 2017; 206:19. [DOI: 10.5694/mja16.00791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022]
|