Jurnal Internasional Afrika vol.10 issue.4 2020
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry
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Title
Jurnal Internasional Afrika vol.10 issue.4 2020
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry
Subject
Prehospital thrombolysis
Implementation
Acute myocardial infarction
St-segment myocardial infarction
Prehospital coronary care
Implementation
Acute myocardial infarction
St-segment myocardial infarction
Prehospital coronary care
Description
Introduction: Evidence-based guidelines advocate percutaneous coronary intervention (PCI) as the mainstay
reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). However, the South African health
system is not well positioned to provide PCI as a ‘mainstay strategy’. In response, the Health Professions Council
of South Africa approved the use of prehospital thrombolysis (PHT) for emergency care practitioners in 2009.
However, since its approval, prehospital thrombolysis has failed to reach a level of systematic uptake indicative
of successful implementation. The current study aimed to explore, through a qualitative inquiry, barriers to PHT
for the treatment of myocardial infarction within a South African context.
Methods: A qualitative single-case study design was used where a series of semi-structured interviews were
conducted involving purposefully selected participants. The case comprised a nationalised private emergency
medical service, and participants were selected in view of relevant experience and knowledge. Requisite data
was conceptualised through the consolidated framework for implementation research, and thematic analysis
outlined the data coding procedures of the study.
Results: The study identified potential barriers to the implementation of PHT. These comprised cost, logistics,
inter-professional collaboration, leadership engagement, and beliefs or scepticism associated with PHT.
Conclusion: A lack of strategic implementation has resulted in a poor introduction of evidenced-based pre-
hospital cardiac care, affecting vulnerable populations who may have otherwise benefited from receiving this
level of care. Given the time-sensitive nature of STEMI management, and severely limited access to ‘primary
reperfusion’, PHT resembles not only a logical but also appealing solution in the South African context.
reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). However, the South African health
system is not well positioned to provide PCI as a ‘mainstay strategy’. In response, the Health Professions Council
of South Africa approved the use of prehospital thrombolysis (PHT) for emergency care practitioners in 2009.
However, since its approval, prehospital thrombolysis has failed to reach a level of systematic uptake indicative
of successful implementation. The current study aimed to explore, through a qualitative inquiry, barriers to PHT
for the treatment of myocardial infarction within a South African context.
Methods: A qualitative single-case study design was used where a series of semi-structured interviews were
conducted involving purposefully selected participants. The case comprised a nationalised private emergency
medical service, and participants were selected in view of relevant experience and knowledge. Requisite data
was conceptualised through the consolidated framework for implementation research, and thematic analysis
outlined the data coding procedures of the study.
Results: The study identified potential barriers to the implementation of PHT. These comprised cost, logistics,
inter-professional collaboration, leadership engagement, and beliefs or scepticism associated with PHT.
Conclusion: A lack of strategic implementation has resulted in a poor introduction of evidenced-based pre-
hospital cardiac care, affecting vulnerable populations who may have otherwise benefited from receiving this
level of care. Given the time-sensitive nature of STEMI management, and severely limited access to ‘primary
reperfusion’, PHT resembles not only a logical but also appealing solution in the South African context.
Creator
Andrew Lynch, Simpiwe Sobuwa, Nicholas Castle
Source
https://doi.org/10.1016/j.afjem.2020.08.001
Date
4 August 2020
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Andrew Lynch, Simpiwe Sobuwa, Nicholas Castle, “Jurnal Internasional Afrika vol.10 issue.4 2020
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/1828.
Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/1828.