Thrombolysis in peripheral general practices in Scotland: another rule of halves.
OBJECTIVE
To facilitate the adoption of thrombolysis by general practitioners in peripheral practices in Scotland.


METHODS
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.


METHODS
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.


METHODS
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.
Rawles
J M
JM
Medicines Assessment Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZN.
Ritchie
L D
LD
D004363:Drug Utilization; D005194:Family Practice / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012606:Scotland; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome