title: Patients' and ambulance service clinicians' experiences of prehospital care for acute myocardial infarction and stroke: a qualitative study.
abstract: BACKGROUND
  Patients with suspected acute myocardial infarction (AMI) and stroke commonly present first to the ambulance service. Little is known about experiences of prehospital care which are important for measuring the quality of services for patients with AMI or stroke.
  
  
  OBJECTIVE
  We explored experiences of patients, who had accessed the ambulance service for AMI or stroke, and clinicians regularly treating patients for these conditions in the prehospital setting.
  
  
  METHODS
  A qualitative research design was employed to obtain rich and detailed data to explore and compare participants' experiences of emergency prehospital care for AMI and stroke.
  
  
  RESULTS
  We conducted 33 semistructured interviews with service users and clinicians and one focus group with five clinicians. Four main themes emerged: communication, professionalism, treatment of condition and the transition from home to hospital. Patients focused on both personal and technical skills. Technical knowledge and relational skills together contributed to a perception of professionalism in ambulance personnel. Patients' experience was enhanced when physical, emotional and social needs were attended to and they emphasised effective communication within the clinician-patient relationship to be the key. However, we found a discrepancy between paramedics' perceptions of patients' expectations and patients' lack of knowledge of the paramedic role.
  
  
  CONCLUSIONS
  Factors that contribute to better patient experience are not necessarily understood in the same way by patients and clinicians. Our findings can contribute to the development of patient experience measures for prehospital care.
authors.affiliation: Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK.
authors.forename: Fiona Jayne
authors.initials: FJ
authors.lastname: Togher
authors.forename: Zowie
authors.initials: Z
authors.lastname: Davy
authors.forename: Aloysius Niroshan
authors.initials: AN
authors.lastname: Siriwardena
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D004632:Emergency Medical Services / Q000592:standards*; D004635:Emergency Medicine / Q000592:standards*; D004645:Empathy; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011361:Professional Competence / Q000592:standards; D036301:Qualitative Research; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000592:standards
keywords: acute myocardial infarct; patient support; prehospital care; stroke