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. 2024 Nov 15;6(12):555-563.
doi: 10.1253/circrep.CR-24-0124. eCollection 2024 Dec 10.

Identification of Physician Concerns Regarding Implementation of the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

Masaya Kurobe  1 , Yosuke Yamanaka  2 , Akihito Uda  2 , Katsuya Mori  2 , Takeshi Akiyama  3 , Ayumi Morishita  3 , Yuta Ishikawa  3 , Louis P Watanabe  3 , Satoshi Ikeda  4 , Koji Maemura  1
Affiliations

Identification of Physician Concerns Regarding Implementation of the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

Masaya Kurobe et al. Circ Rep. .

Abstract

Background: The Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) is a regional pathway that aims to standardize practices related to the treatment of acute myocardial infarction in order to improve patient prognoses. This study aimed to understand physician backgrounds and concerns regarding implementation of the NASP.

Methods and results: This exploratory sequential mixed-methods study was developed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Following focus group interviews, the web-based, self-administered questionnaire survey with a cross-sectional study design was given to 62 physicians who practiced at acute care hospitals (ACHs), primary care hospitals (PCHs), or outpatient clinics (OCs) in the Nagasaki prefecture. Hayashi's quantitative theory type II analysis was used to assess the quantitative relationship between physician characteristics and their concerns. In addition, physicians were clustered based on the types of concerns they had. Our results demonstrated that specialists in cardiovascular disease held more concerns regarding implementation of the NASP. Furthermore, workload burden was found to be the most common concern among these physicians. Cooperation between physicians at ACHs and physicians at PCHs/OCs was also found to be vital for the NASP.

Conclusions: Interventions such as modifications to the NASP operation may assist in alleviating concerns regarding the NASP and allow for the development of tailored interventions and effective expansion of the pathway.

Keywords: Clinical pathway; Lipid management; Mixed methods; RE-AIM framework; Secondary prevention of acute myocardial infarction.

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Conflict of interest statement

M.K. has received speaker honoraria from Novartis Pharma K.K. and Amgen K.K. S.I. has received speaker honoraria from Daiichi Sankyo Company, Ltd, Kowa Company, Ltd, Novartis Pharma K.K., Viatris Pharmaceuticals Japan Inc., and Bayer Yakuhin, Ltd. K. Maemura has received speaker honoraria from Daiichi Sankyo Company, Ltd, Novartis Pharma K.K., Takeda Pharmaceutical Company Ltd, Pfizer Japan Inc., MSD K.K., Bayer Yakuhin, Ltd, Kowa Company, Ltd, Amgen K.K., AstraZeneca K.K., and Viatris Pharmaceuticals Japan Inc. K. Maemura is a member of Circulation Reports’ Editorial Team. Y.Y., A.U., and K. Mori are employees of Novartis Pharma K.K. T.A., A.M., Y.I., and L.P.W. declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Dendrogram of the types of concerns regarding the implementation of the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP).
Figure 2.
Figure 2.
Correlation coefficients between participant characteristic and participant-reported data were calculated using Cramer’s V statistic. Blue indicates a weak correlation, and red indicates a strong correlation. The magnitude is illustrated by color depth. ACS, acute coronary syndrome; NASP, Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway.
Figure 3.
Figure 3.
Physician backgrounds and their associations with concerns regarding the implementation of the NASP using Hayashi’s Quantitative Theory Type 2. ACH, acute care hospital; NASP, Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway; OC, outpatient clinic; PCH, primary care hospital.
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