title: The effect of health care provider consultation on acute coronary syndrome care-seeking delay.
abstract: OBJECTIVE
  The time required for health care provider (HCP) consultation during acute coronary syndrome (ACS) has not been systematically studied. This study seeks to understand who calls an HCP and the duration of HCP evaluation during ACS.
  
  
  METHODS
  Interviews were conducted with 1102 hospitalized patients with ACS in Columbus, Ohio. At discharge, diagnoses were acute myocardial infarction (560), unstable angina (214), cardiac disease (122), and noncardiac emergencies (206).
  
  
  RESULTS
  Among the 1102 patients studied, 40.9% (451) contacted an HCP. Situational factors were more important than demographic factors in accounting for medical evaluation phase incidence and duration. Advice from HCPs to call the emergency medical services or travel to the emergency department reduced medical evaluation phase duration. The median total time duration was 6 hours for HCP consulters and 1 hour 30 minutes for nonconsulters (P < .001). Patients foregoing HCP consultation experienced significantly greater hemodynamic instability than patients contacting an HCP. Calling an HCP significantly (P < .001) reduced emergency medical services use.
  
  
  CONCLUSIONS
  Consulting an HCP during ACS extended total time duration from symptom onset to emergency department arrival. In general, patients calling an HCP experienced a less severe ACS event than patients not contacting an HCP. There is a need for an epidemiologic study of calls to HCPs to develop a protocol for ACS call management.
authors.affiliation: Department of Sociology, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Alonzo
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013997:Time Factors