Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease - The Rapid Early Action for Coronary Treatment (REACT) trial
Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease - The Rapid Early Action for Coronary Treatment (REACT) trial
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DOI：
10.1001/jama.284.1.60
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发表时间：
2000-07-05
影响因子：
120.7
通讯作者：
Simons-Morton, DG
中科院分区：
文献类型：
--
作者：
Luepker, RV;Raczynski, JM;Simons-Morton, DG
目的评价一种社区干预措施，以减少患者从症状出现到住院的延迟，并增加紧急医疗服务(EMS)的使用率。设计和设置冠状动脉治疗快速早期行动试验，这是一项从1995年到1997年在美国20个城市进行的随机试验(10对配对；共有59944名30岁或30岁以上的成年人因胸痛到医院急诊科就诊，其中20364人入院时符合疑似急性冠心病的主要人群标准，并因冠心病相关诊断出院。干预每对中的一个城市被随机分配到针对大众媒体、社区组织以及专业、公共和患者教育的18个月的干预中，以增加针对急性心肌梗死症状的适当的患者行动(主要人口，n=10563)。每对中的其他城市被随机分配到参考状态(主要人口，n=9801)。主要结果衡量从症状出现到急诊到达和EMS使用的时间，比较干预和参考城市对。结果总体人口调查提供了公众对计划信息的意识和知识增加的证据。在干预组和参照组中，患者从症状出现到到达医院的时间在基线(中位数，140分钟)是相同的。干预社区的延迟时间每年减少-4.7%(95%可信区间[CI]，-8.6%至-0.6%)，但与参考社区观察到的变化(-6.8%/年；95%可信区间，-14.5%至1.6%；P=.54)没有显著差异。与参考社区相比，干预社区主要研究人群的EMS使用量显著增加，净影响为20%(95%CI，7%-34%；P<；.005)，因胸痛而出现急诊的患者和出院的胸痛患者的ED总次数以及ED出院的胸痛患者使用EMS的总数没有显著变化。结论在本研究中，尽管干预社区增加了适当的EMS使用量，但胸痛患者从症状出现到住院的时间在不同组之间没有差异。如果要进一步减少疑似急性心肌梗死患者从症状出现到住院表现的延迟时间，就需要采取新的策略。
Context Delayed access to medical care in patients with acute myocardial infarction (AMI) is common and increases myocardial damage and mortality.Objective To evaluate a community intervention to reduce patient delay from symptom onset to hospital presentation and increase emergency medical service (EMS) use.Design and Setting The Rapid Early Action for Coronary Treatment Trial, a randomized trial conducted from 1995 to 1997 in 20 US cities (10 matched pairs; population range, 55777-238912) in 10 states.Participants A total of 59944 adults aged 30 years or older presenting to hospital emergency departments (EDs) with chest pain, of whom 20364 met the primary population criteria of suspected acute coronary heart disease on admission and were discharged with a coronary heart disease-related diagnosis.Intervention One city in each pair was randomly assigned to an 18-month intervention that targeted mass media, community organizations, and professional, public, and patient education to increase appropriate patient actions for AMI symptoms (primary population, n = 10563). The other city in each pair was randomly assigned to reference status (primary population, n = 9801).Main Outcome Measures Time from symptom onset to ED arrival and EMS use, compared between intervention and reference city pairs.Results General population surveys provided evidence of increased public awareness and knowledge of program messages. Patient delay from symptom onset to hospital arrival at baseline (median, 140 minutes) was identical in the intervention and reference communities. Delay time decreased in intervention communities by -4.7% per year (95% confidence interval [CI], -8.6% to -0.6%), but the change did not differ significantly from that observed in reference communities (-6.8% per year; 95% CI, -14.5% to 1.6%; P = .54). EMS use by the primary study population increased significantly in intervention communities compared with reference communities, with a net effect of 20% (95% CI, 7%-34%; P < .005), Total numbers of ED presentations for chest pain and patients with chest pain discharged from the ED, as well as EMS use among patients with chest pain released from the ED, did not change significantly.Conclusions in this study, despite an Is-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI.