title: Do physicians modify their prehospital management of patients in response to a public campaign on chest pain?
abstract: The goals of this study were to analyze the impact of a public campaign on chest pain on physicians involved in the prehospital care of patients with this symptom, in terms of physician delay, rates of immediate hospitalization, and of transportation by ambulance. Prehospital delays and decisions for all 866 patients with chest pain managed by the community and generalist physicians or by emergency physicians, who presented to the emergency department of a teaching hospital during the 12 months of the campaign, were compared with those of all 749 patients with similar presentations during the 12 months before it. When community and generalist physicians were involved, median (110 minutes) physician delay did not decrease during the campaign, whereas it decreased from 65 to 56 minutes (p <0.003) when emergency physicians were involved. Rates of immediate hospitalization (73%) and of transportation by ambulance (47%) of patients managed by community and generalist physicians were unaffected by the campaign, whereas they increased from 96% and 89%, respectively, to 98% (p = 0.09) and 94% (p <0.02) when emergency physicians were involved. Similar observations were made in patients with confirmed acute myocardial infarction and unstable angina and remained highly significant after adjustment for differences in clinical characteristics. Thus, community and generalist physicians did not significantly modify their prehospital management of patients with chest pain despite a public campaign. To be successful, guidelines on the matter have to be developed with the active participation of these physicians.
authors.affiliation: Clinique de Médecine II, Department of Medicine, Hôpital Cantonal Universitaire, Geneva, Switzerland.
authors.forename: J M
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: C
authors.initials: C
authors.lastname: Lovis
authors.forename: Y
authors.initials: Y
authors.lastname: Green
authors.forename: C
authors.initials: C
authors.lastname: Héliot
authors.forename: S
authors.initials: S
authors.lastname: Mischler
authors.forename: L
authors.initials: L
authors.lastname: Séchaud
authors.forename: P F
authors.initials: PF
authors.lastname: Unger
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006293:Health Promotion; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013557:Switzerland