Thrombolysis in peripheral general practices in Scotland: another rule of halves

Abstract

Objective: To facilitate the adoption of thrombolysis by general practitioners in peripheral practices in Scotland.

Design: Survey of practice policies on the management of acute myocardial infarction before and after practice visits by a consultant physician acting as a facilitator; survey of hospital consultants' attitudes to thrombolysis by general practitioners.

Setting: One hundred and eighty-two practices, with an enlisted total of 550,000 patients, located at least 30 minutes from a district general hospital; 23 such hospitals serving these peripheral practices.

Main outcome measures: Possession of electrocardiograph and defibrillator; adoption of a policy of giving thrombolytic therapy.

Results: The majority of practices possessed an electrocardiograph (87%) and a defibrillator (76%). At the time of the visits, 67 practices (37%) already had a policy of giving thrombolytic therapy. When contacted one year later 91 practices (50%) had such a policy. In the interval between visits and follow-up, few had received any encouragement from any source to use this treatment. Hospital consultants' attitudes to thrombolysis by general practitioners were generally negative, and support from local and national health authorities has been inadequate.

Conclusions: Provision of timely thrombolytic therapy for the one tenth of the Scottish population living at least 30 minutes from a district general hospital is a major public health problem for which there is a ready solution: pre-hospital thrombolysis administered by general practitioners has been shown to be feasible, fast, safe, efficacious and cost-effective. To translate this evidence into practice requires a concerted effort from all the professionals involved, and must be directed and supported by local and national management of the National Health Service in Scotland.