Challenges of the primary health care system in timely treatment and hospitalization of patients with acute myocardial infarction in Georgia

Authors

Keywords:

primary health care, acute myocardial infarction, family doctor

Abstract

Introduction: The family physician plays a major role in the management and emergency referral of patients with angina pectoris. The purpose of the study is to study the challenges of the primary health care system in Georgia in the timeliness of treatment and, if necessary, hospitalization of patients with acute myocardial infarction in the pre-hospital stage. Methodology: within the framework of quantitative research, a survey of doctors of selected cardiology clinics and patients with acute myocardial infarction was conducted. Results, Discussion: Patients contact emergency medical care directly, without contacting their family doctor. During illness, only 11% of patients consulted a family doctor, which shows that primary health care in Georgia is not developed at an appropriate level. 95.8% of patients who went directly to emergency medical services at the onset of symptoms took less than 2 hours to receive emergency medical services. However, patients who contacted their family physician before hospitalization had a relatively shorter delay time and therefore referred to an emergency medical service earlier, up to 6 hours earlier, than patients who self-medicated. This is because family doctors properly perceive the symptoms and try to refer patients to the emergency medical service in time if necessary. In contrast to this, during self-medication, which also has a large share in our study (n=98, 22.5%), the delay time for emergency medical assistance is relatively high (n=90, 66.7%). Conclusion: It is recommended to carry out public health campaigns that will help patients with chest pain to contact the emergency medical service immediately. If the discomfort is minor, it is more appropriate to consult a family doctor.

References

ვერულავა თ. პირველადი ჯანდაცვის სისტემა და მისი როლი ჯანმრთელობის კაპიტალის ამაღლებაში. რუსთაველის ეროვნული სამეცნიერო ფონდი. 2021.

მიქავა ნ, გაბრიჭიძე ს. სუსტი პირველადი ჯანდაცვა - ჯანდაცვაზე საყოველთაო ხელმისაწვდომობის ბარიერი. Welfare Foundation. 2019.

ჯანმრთელობის დაცვა. სტატისტიკური ცნობარი. 2013. საქართველო. საქართველოს შრომის, ჯანმრთელობისა და სოციალური დაცვის სამინისტრო. დაავადებათა კონტროლისა და საზოგადოებრივი ჯანდაცვის ეროვნული ცენტრი. თბილისი. 2014.

ჯანმრთელობის დაცვა. სტატისტიკური ცნობარი. 2019. საქართველო. საქართველოს შრომის, ჯანმრთელობისა და სოციალური დაცვის სამინისტრო. დაავადებათა კონტროლისა და საზოგადოებრივი ჯანდაცვის ეროვნული ცენტრი. თბილისი. 2020.

Beeleonie B, Kusmana D. Role of general practitioner in the management of acute myocardial infarction. Med J Indones. 2005;14(4):249-52.

Bruyninckx R, Van den Bruel A, Aertgeerts B, Van Casteren V, Buntinx F. Half of the patients with chest pain that are urgently referred are transported in unsafe conditions. Eur J Emerg Med 2008; 15:330–333.

Gärtner C, Walz L, Bauernschmitt E, Ladwig KH. The causes of prehospital delay in myocardial infarction. Dtsch Arztebl Int. 2008 Apr;105(15):286-91.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.

Ibanez Borja, Stefan James, Stefan Agewall, Manuel J Antunes, Chiara Bucciarelli-Ducci, Héctor Bueno, Alida L P Caforio, Filippo Crea, John A Goudevenos, Sigrun Halvorsen, Gerhard Hindricks, Adnan Kastrati, Mattie J Lenzen, Eva Prescott, Marco Roffi, Marco Valgimigli, Christoph Varenhorst, Pascal Vranckx, Petr Widimský, ESC Scientific Document Group , 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC), European Heart Journal, Volume 39, Issue 2, 07 January 2018, Pages 119–177, https://doi.org/10.1093/eurheartj/ehx393

Ladwig KH, Meisinger C, Hymer H, et al. Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction. Int J Cardiol 2011;152:350–5.

McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol. 2013;168(3):2706–13.

Pattenden J, Watt I, Lewin RJP, Stanford N. Decision making processes in people with symptoms of acute myocardial infarction: qualitative study. BMJ 2002; 324:1006.

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Rev Esp Cardiol (Engl Ed). 2016;69(10):939.

Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012;33:2569–619.

Thylen I, Ericsson M, Hellstrom Angerud K, Isaksson RM, Sederholm Lawesson S, SymTime study g. First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open. 2015;5(4):e007059.

Thylen I, Ericsson M, Hellstrom Angerud K, Isaksson RM, Sederholm, Lawesson S, SymTime study g. First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open. 2015;5(4):e007059.

Johansson I, Stromberg A, Swahn E. Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung. 2004;33(5):291–300.

Verdon F, Burnand B, Herzig L, Junod M, Pecoud A, Favrat B. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract. 2007;8:51.

Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2014;35:2541–619.

Van Severen E, Willemsen R, Vandervoort P, Sabbe M, Dinant GJ, Buntinx F. How do patients with chest pain access Emergency Department care? Eur J Emerg Med. 2017 Dec;24(6):423-427.

Verulava T. Barriers to effective communication between family physicians and patients in Georgia. Family Medicine & Primary Care Review 2023; 25(1): 80–85.

Verulava T, Jorbenadze A. Primary health care reforms in Georgia: the experience and challenges. Arch Balk Med Union. 2022;57(4):384-389.

Verulava T. Factors influencing medical students’ choice of family medicine. Family Medicine & Primary Care Review. 2022;24(1):66-70.

Verulava T, Jorbenadze R, Karimi L. Patients’ perceptions about access to health care and referrals to family physicians in Georgia. Archives of the Balkan Medical Union. 2020; 55(4): 642-650.

Verulava T, Dangadze B, Jorbenadze R, Lordkipanidze A, Karimi L, Eliava E, Maglakelidze T. The Gatekeeper Model: patient’s view on the role of the family physician. Family Medicine & Primary Care Review. 2020; 22(1): 75–79.

Verulava T, Beruashvili D, Jorbenadze R, Eliava E. Evaluation of patient referrals to family physicians in Georgia. Family Medicine & Primary Care Review 2019; 21(2):180-183

Wallbridge DR, Tweddel AC, Martin W, Cobbe SM. The potential impact of patient self-referral on mortality in acute myocardial infarction. Q J Med 1992; 85:901–909.

Published

2024-05-28

How to Cite

Verulava, T., & Arakishvili, L. (2024). Challenges of the primary health care system in timely treatment and hospitalization of patients with acute myocardial infarction in Georgia. Health Policy, Economics and Sociology, 8(1). Retrieved from https://heconomic.cu.edu.ge/index.php/healthecosoc/article/view/7846

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