title: Influences on general practitioners' use of pre-hospital thrombolysis: a qualitative study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Aberdeen, Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY.
authors.forename: Pauline
authors.initials: P
authors.lastname: Williams
authors.forename: Christine
authors.initials: C
authors.lastname: Bond
authors.forename: Philip
authors.initials: P
authors.lastname: Hannaford
authors.forename: Lewis
authors.initials: L
authors.lastname: Ritchie
mesh_terms: D002637:Chest Pain / Q000188:drug therapy*; D003657:Decision Making; D004363:Drug Utilization / Q000592:standards*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods; D005194:Family Practice / Q000379:methods / Q000592:standards*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007407:Interviews as Topic; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D036301:Qualitative Research; D012449:Safety; D012606:Scotland; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*
chemical_list: D005343:Fibrinolytic Agents