Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Yin, Xiaoxv; Yang, Tingting; Gong, Yanhong; Zhou, Yanfeng; Li, Wenzhen; Song, Xingyue; Wang, Mengdie; Hu, Bo; Lu, Zuxun

doi:10.1161/strokeaha.115.011877

Cited by 26 publications

(41 citation statements)

References 14 publications

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“…A number of obstacles to the extensive use of IV thrombolysis have been identified, and patients’ delayed presentation is believed to be the most important constraint (Dirks & Dippel, ; Eissa, Krass, & Bajorek, ; Yin et al., ). However, we previously found 37.9% of the investigated AIS patients presented within 4 hr after symptom onset and had enough time to receive thrombolytic therapy (Zhou et al., ).…”

Section: Introductionmentioning

confidence: 99%

Chinese neurologists’ perspective on intravenous thrombolysis for acute ischemic stroke

et al. 2017

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ObjectivesThis study examined the neurologists’ perspective toward intravenous thrombolysis for the treatment of acute ischemic stroke and the influencing factors in a Chinese Province.MethodsA cross‐sectional study was conducted from 1 October 2014 to 31 January 2015. A total of 719 neurologists from 66 hospitals in Hubei Province were included. A questionnaire was designed, and multivariable logistic regression models were used to identify the factors associated with the neurologists’ perspective toward intravenous thrombolysis.ResultsAmong the responding neurologists, 67.3% reported using intravenous thrombolysis and 32.9% believed the treatment was unsafe. Approximately 51.4% reported deficits in their knowledge of intravenous thrombolysis and 45.8% felt unconfident about their ability to employ the treatment. The majority (90.1%) supported hospitals in performing intravenous thrombolysis for eligible patients. Their safety concern was associated with hospital grade (odds ratio[OR] = 2.3; 95% confidence interval [CI], 1.4–3.7) and previous experiences with thrombolysis (OR = 3.1; 95% CI, 2.1–4.6). Their confidence was associated with their educational background (OR = 2.5; 95% CI, 1.3–4.5), knowledge mastery (OR = 10.4; 95% CI, 6.6–16.3), and previous experiences with thrombolysis (OR = 3.3; 95% CI, 2.1–5.3). Their attitudes were associated with gender (OR = 0.6; 95% CI, 0.3–1.0) and previous experiences with thrombolysis (OR = 4.9; 95% CI, 2.5–9.4).ConclusionsMost neurologists in Hubei Province, China, identified with intravenous thrombolysis for the treatment of acute ischemic stroke. However, they were weak in knowledge and lack confidence. Therefore, training, especially practical training, is needed to promote the use of thrombolysis in the region.

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Section: Introductionmentioning

confidence: 99%

Chinese neurologists’ perspective on intravenous thrombolysis for acute ischemic stroke

et al. 2017

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“…In real-world survey of acute stroke patients arriving at hospital, the utilization rate of EMS in rural area was markedly lower than that in urban China (9.9% vs. 18.3%-23.1%; Jin et al, 2012;Yin et al, 2016). Compared with urban area, there were higher inefficiency of medical service system and poor allocation of healthcare resources in rural China (Chen, Yin, & Xie, 2014;Zhai et al, 2017;Zheng, Gong, & Zhang, 2019).…”

Section: Discussionmentioning

confidence: 96%

“…Although more than four-fifths of the patients in the surgery group were able to identify symptoms of stroke onset, they did not respond better than the nonsurgery group. In clinical practice, less than half of patients identified a stroke onset, probably due to difficulty relating the depictions of stroke symptoms to the real situation (Teuschl & Brainin, 2010;Yin et al, 2016). In addition, there was no difference in SRR and CAR among surgery group with or without stroke history during survey.…”

Section: Discussionmentioning

confidence: 96%

“…We speculate that it is hard for them to think of stroke onset in the future, though in fact carotid artery stenosis and coronary heart disease both increase the stroke risk and indicate the presence of multiple risk factors (Anderson & Morrow, 2017;Mathiesen et al, 2001;Sobiczewski et al, 2013;Yusuf et al, 2004). In clinical practice, less than half of patients identified a stroke onset, probably due to difficulty relating the depictions of stroke symptoms to the real situation (Teuschl & Brainin, 2010;Yin et al, 2016). Only 31.5% of patients would discuss their long-term stroke risk with surgeons when they decided to undergo carotid endarterectomy, markedly lower than those rejecting surgery (72.4%; Middleton, Gattellari, Harris, & Ward, 2006).…”

Section: Discussionmentioning

confidence: 98%

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Cardiovascular surgery experience does not significantly improve patients' response to stroke

Anderson

Gao

et al. 2019

Brain and Behavior

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Objectives Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS. Methods We performed a cross‐sectional community‐based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively. Results 0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99–1.98, p = .0572). Conclusions Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.

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“…However, the use of EMS at the time of stroke involves a complex "knowledge-to-action" process [8,9]. Although recognition of stroke symptoms may prompt the intent to call EMS [10,11], knowledge of stroke does not necessarily imply that the individual will call EMS [9,12,13]. Thus, only some of the individuals who recognize the onset of a stroke will call an ambulance [9,10,[12][13][14], indicating a huge gap between the knowledge of stroke symptoms and appropriate action [6].…”

Section: Introductionmentioning

confidence: 99%

Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China

Cui

Anderson

et al. 2019

Preprint

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Background: As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40–74- and 75–99-year-old adults. Methods: Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40–74 and 75–99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke. Results: In the 40–74 and 75–99 age groups, the rates of participants who chose “Self-observation at home” were 3.0% (3912) and 3.5% (738), respectively; the rates of “Wait for family, then go to hospital” were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40–74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75–99 age group. Conclusions: Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population. Different strategies that mainly focus on changing the “Wait for family” behavior and emphasize on immediately calling EMS are recommended for both age groups.

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Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China

Cited by 26 publications

References 14 publications

Chinese neurologists’ perspective on intravenous thrombolysis for acute ischemic stroke

Chinese neurologists’ perspective on intravenous thrombolysis for acute ischemic stroke

Cardiovascular surgery experience does not significantly improve patients' response to stroke

Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China

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