Unscheduled care pathways in patients with myocardial infarction in Scotland

P. Hodgins, Megan A. Mcminn, A. Shah, M. Reed, S. Mercer, B. Guthrie
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引用次数: 2

Abstract

Objective Treatment 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. Methods Retrospective 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. Results 26 325 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). Conclusion Unscheduled 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.
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苏格兰心肌梗死患者的计划外护理途径
目的急性心肌梗死(MI)的治疗需要将胸痛患者迅速转移到医院,然而,计划外的护理途径在其直接性方面各不相同(最少的接触者入院)。目的是研究非计划的护理途径及其与心肌梗死患者死亡率的关系。方法回顾性人群研究2015年1月1日至2017年12月31日期间在苏格兰医院诊断为心肌梗死的所有患者。使用苏格兰国家卫生服务所有非计划护理服务(NHS24电话分诊服务、非工作时间初级保健、救护车、急诊科(ED))的关联数据来定义连续的非计划护理途径(途径),这些途径按初次接触进行分类,以及它们是否“直接”(首次接触和入院之间的接触次数最少)。分析估计了包括所有协变量的调整模型的or和95% ci。结果26 325例心肌梗死患者(男性63.1%,65岁以上61.6%),其中5.6%在28天内死于冠心病。47.0%的患者第一次非预约护理联系是救护车,23.3%的患者直接到急诊科就诊,18.7%的患者通过电话分诊。92.1%为直接途径。与其他初始接触者相比,从电话分诊开始的途径更有可能是间接的(调整OR (aOR) 1.97, 95% CI 1.61至2.40)。与直接途径相比,从电话分诊开始的间接途径与更高的死亡率相关(aOR 1.97, 95% CI 1.61至2.40),从其他服务开始的间接途径与更高的死亡率相关(aOR 1.55, 95% CI 1.19至2.01),但从电话分诊开始的直接途径与更高的死亡率无关(aOR 0.87, 95% CI 0.74至1.02)。结论:苏格兰因心肌梗死入院的非计划护理途径通常是直接的,但从电话分诊开始的护理途径通常是间接的。这些间接途径与较高的死亡率有关。
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