BMJ 1994;309:379 (6 August)

General practice

Attitudes of general practitioners to prehospital thrombolysis

J Rawles 

Medicines Assessment Research Unit, University of Aberdeen, Aberdeen AB9 2ZD.

Abstract

Objective : To investigate reasons for general practitioners not giving thrombolytic treatment to eligible patients with acute myocardial infarction.
Design : Postal questionnaires were sent to 424 general practitioners.
Subjects : 97 general practitioners who had taken part in the Grampian region early anistreplase trial, 185 whose practices in Scotland were at least 24 km from a district general hospital, and 142 who had attended postgraduate conferences at which thrombolysis had been discussed; 87, 158, and 125 respectively responded.
Main outcome measures : Answers to questions about readiness to use thrombolytic treatment.
Results : Response rate was 87% (370/424). Almost all respondents (350) were convinced of benefits of thrombolysis for acute myocardial infarction, and 277 were convinced that there were additional benefits from its administration in the community at first opportunity. Most doctors working 16 km or more from hospital thought that giving treatment at home would appreciably save time (200/ 274). Most doctors agreed that they could make time to give thrombolytic treatment (278), and would be willing to record an electrocardiogram (284), and would be able to interpret it (280). Sixty four respondents (17%) reported using thrombolytic treatment in previous year. Among non-users, 150 (49%) were unwilling to use thrombolytic treatment without further training. While many non-users (210 (69%)) were willing to use thrombolytic treatment without encouragement from Department of Health, 184 (60%) were unwilling to use it unless encouraged to do so by their local cardiologist.
Conclusions : The need to become better informed about thrombolysis and lack of encouragement from local cardiologists were important factors preventing wider use of thrombolytic treatment in the community by general practitioners.

Clinical implications

  • Clinical implications

  • Domiciliary thrombolysis for acute myocardial infarction may save time, particularly in rural locations, but few general practitioners give it

  • In this postal survey of general practitioners most respondents were convinced of benefits to giving thrombolytic treatment in the community, but only 17% had given it in the previous year

  • Most doctors said that they could make time to give the treatment and were able to record and interpret electrocardiograms

  • Important factors preventing doctors from giving treatment were the need for more training and lack of encouragement from local cardiologists

  • General practitioners may need more training and support if more patients with myocardial infarction are to receive thrombolytic treatment at home


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Relevant Article

Prehospital thrombolysis Views of non-users ignored
I D Clark, I Bonavia, K Cooney, P D Thomas, and W E Leverton
BMJ 1994 309: 871-872. [Extract] [Full Text]

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  • Rawles, J, Sinclair, C, Jennings, K, Ritchie, L, Waugh, N (1998). Audit of prehospital thrombolysis by general practitioners in peripheral practices in Grampian. Heart 80: 231-234 [Abstract] [Full text]  
  • Clark, I D, Bonavia, I, Cooney, K, Thomas, P D, Leverton, W E (1994). Prehospital thrombolysis Views of non-users ignored. BMJ 309: 871-872 [Full text]  
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