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Journal of Public Health 26(1) © Faculty of Public Health 2004; all rights reserved.

Influences on general practitioners' use of pre-hospital thrombolysis: a qualitative study



Pauline Williams, SHO*, Grampian University Hospitals Trust

Christine Bond, Professor of Primary Care (Pharmacy)

Philip Hannaford, Professor of Primary Care

Lewis Ritchie, Mackenzie Professor of General Practice
University of Aberdeen, Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY

Address correspondence to Professor Christine Bond. E-mail: c.m.bond{at}abdn.ac.uk

Background The aim of the study was to determine factors influencing general practitioners' (GPs') decisions to provide pre-hospital thrombolysis for acute myocardial infarction.

Methods Semi-structured, face-to-face interviews were carried out with 21 GPs in Grampian (10 rural; 11 urban).

Results The GPs believed that thrombolysis has an important role in the management of acute myocardial infarction, but urban practitioners were not convinced that time savings could be made by GP provision. Practical issues such as taking an electrocardiogram, ascertaining contra-indications in patients, maintaining skills, equipment, and workload were barriers preventing the provision of pre-hospital thrombolysis. There was a sense that primary care needed to feel that it is initiating change rather than having change thrust upon it.

Conclusion Decision-making processes in primary care are complex, even when the evidence supporting change is strong. Health service planners wishing to implement successful change need to consider other issues such as practical matters, support structures, current morale and practitioner perceptions of control.

Keywords: thrombolysis, general practice, myocardial infarction, community


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