Influences upon the diffusion of thrombolysis for acute myocardial infarction in England: case study.
OBJECTIVE
To investigate the factors that influenced the adoption and diffusion of thrombolysis in acute myocardial infarction in England and to verify usage data from 1981 to 2001.


METHODS
Survey of cardiologists in England using a pre-prepared time line of historical events and a plot of thrombolysis diffusion since 1981. The cardiologists were divided into three groups that were provided with (i) the time line only, (ii) the diffusion curve only, and (iii) the time line and the diffusion curve.


RESULTS
The GISSI and ISIS-2 clinical trials were perceived to have had a significant influence upon the initial diffusion of thrombolysis in England occurring over the 3 years after launch. Other positive influences included the initial listing in the national formulary, the change to administration in emergency departments, the rise in evidence-based medicine, and production of national guidance.


CONCLUSIONS
Although it is apparent that the overall influences on adoption and diffusion of thrombolysis were multiple; clinical trials, service developments, and national guidelines all were judged to have played a part. The GISSI and ISIS-2 clinical trials were confirmed as the major influence on initial adoption.
Cook
Alison
A
Department of Public Health and Epidemiology, The University of Birmingham, UK. a.m.cook@bham.ac.uk
Packer
Claire
C
Stevens
Andrew
A
Quinn
Tom
T
D001291:Attitude of Health Personnel; D003625:Data Collection; D004059:Diffusion of Innovation; D004739:England; D006291:Health Policy; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013927:Thrombosis / Q000517:prevention & control