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.
- health care delivery
- acute myocardial infarction
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XY and YH contributed equally.
Contributors XY and YH are joint first authors who equally contributed to the first draft. HL and MT act as guarantors. MT, YoL, JZ, NT and JC designed the study. XY, YH and JZ were responsible for data analysis and interpretation. YH, FS, JL, GS, YaL, JY, YH, MS, CC and QX were responsible for data collection and data transcript. All authors contributed to critical revision of the manuscript.
Funding The study was funded by the Science and Technology Planning Project of Guangdong Province (2014B070706010), Guangdong Provincial People’s Hospital Clinical Research Fund (2014dzx02), and Access Research Fund of China Heart House (2018-CCA-AF-037). XY is supported by the University of New South Wales Scientia PhD Scholarship. HL is funded by a George Institute Program Grant Fellowship.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was granted by the Research Ethics Committee of Guangdong Provincial People’s Hospital (registration no GDREC2015433H).
Provenance and peer review Not commissioned; internally peer reviewed.
Data availability statement All the data of this research are unidentified. Data can be accessed upon reasonable request by contacting the corresponding author via firstname.lastname@example.org.
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