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Original research
Patient-level and system-level barriers associated with treatment delays for ST elevation myocardial infarction in China
  1. Xuejun Yin1,
  2. Yibo He2,
  3. Jing Zhang3,
  4. Feier Song4,
  5. Jin Liu2,
  6. Guoli Sun2,
  7. Yan Liang5,
  8. Jianfeng Ye6,
  9. Yunzhao Hu7,
  10. Mingcai Song8,
  11. Cong Chen5,
  12. Qingbo Xu5,
  13. Ning Tan2,
  14. Jiyan Chen2,
  15. Yong Liu2,
  16. Hueiming Liu1,
  17. Maoyi Tian1,9
  1. 1The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department 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
  3. 3School of Public Health, University of New South Wales, Sydney, New South Wales, Australia
  4. 4Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  5. 5Department of Cardiology, Maoming People’s Hospital, Maoming, China
  6. 6Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
  7. 7Department of Cardiology, The First People's Hospital of Shunde, Shunde, China
  8. 8Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
  9. 9The George Institute for Global Health, Beijing, China
  1. Correspondence to Dr 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; liuyong2099{at}126.com

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.

  • health care delivery
  • acute myocardial infarction
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Footnotes

  • Twitter @MaoyiT

  • 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 liuyong2099@126.com.

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