Ruth M Mellor1, Sheila Bailey2, James Sheppard3, Peter Carr4, Tom Quinn5, Amunpreet Boyal6, David Sandler4, Don G Sims6, Jonathan Mant7, Sheila Greenfield8, Richard J McManus3. 1. NHS Lanarkshire, Bothwell, UK. 2. Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. 3. Nuffield Department of Primary Care Health Sciences, National School for Primary Care Research, University of Oxford, Oxford, UK. 4. Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK. 5. School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. 6. University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK. 7. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK. 8. Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. Electronic address: s.m.greenfield@bham.ac.uk.
Abstract
STUDY OBJECTIVE: We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms. METHODS: This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners). Patients were asked about their previous experience of having had a stroke and their initial engagement with health services. "One sheet of paper" and thematic analyses were used. RESULTS: Three potential types of delay were identified from onset of symptoms to accessing stroke care in the hospital: primary delays caused by lack of recognition of symptoms or not dealing with symptoms immediately, secondary delays caused by initial contact with nonemergency services, and tertiary delays in which health service providers did not interpret the patients' presenting symptoms as suggestive of stroke. The main factors determining the speed of action by patients were the presence and influence of a bystander and the perceived seriousness of symptoms. CONCLUSION: Despite campaigns to increase public awareness of stroke symptoms, the behavior of both patients and health service providers apparently led to delays in the recognition of and response to stroke symptoms, potentially reducing access to optimum and timely acute specialist assessment and treatment for acute stroke.
STUDY OBJECTIVE: We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms. METHODS: This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners). Patients were asked about their previous experience of having had a stroke and their initial engagement with health services. "One sheet of paper" and thematic analyses were used. RESULTS: Three potential types of delay were identified from onset of symptoms to accessing stroke care in the hospital: primary delays caused by lack of recognition of symptoms or not dealing with symptoms immediately, secondary delays caused by initial contact with nonemergency services, and tertiary delays in which health service providers did not interpret the patients' presenting symptoms as suggestive of stroke. The main factors determining the speed of action by patients were the presence and influence of a bystander and the perceived seriousness of symptoms. CONCLUSION: Despite campaigns to increase public awareness of stroke symptoms, the behavior of both patients and health service providers apparently led to delays in the recognition of and response to stroke symptoms, potentially reducing access to optimum and timely acute specialist assessment and treatment for acute stroke.
Authors: Ruth M Mellor; James P Sheppard; Elizabeth Bates; George Bouliotis; Janet Jones; Satinder Singh; John Skelton; Connie Wiskin; Richard J McManus Journal: Br J Gen Pract Date: 2015-07 Impact factor: 5.386
Authors: Andrew Wilson; Dawn Coleby; Emma Regen; Kay Phelps; Kate Windridge; Janet Willars; Tom Robinson Journal: BMJ Open Date: 2016-05-17 Impact factor: 2.692