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Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions

Farquharson, Barbara; Abhyankar, Purva; Smith, Karen; Dombrowski, Stephan U; Treweek, Shaun; Dougall, Nadine; Williams, Brian; Johnston, Marie

Authors

Barbara Farquharson

Purva Abhyankar

Karen Smith

Stephan U Dombrowski

Shaun Treweek

Brian Williams

Marie Johnston



Abstract

Background: Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay.

Objective: To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical.

Methods: The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies.

Results: From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay.

Conclusions: Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful.

Citation

Farquharson, B., Abhyankar, P., Smith, K., Dombrowski, S. U., Treweek, S., Dougall, N., Williams, B., & Johnston, M. (2019). Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart, 6(1), Article e000975. https://doi.org/10.1136/openhrt-2018-000975

Journal Article Type Article
Acceptance Date Nov 21, 2018
Online Publication Date Feb 27, 2019
Publication Date 2019-02
Deposit Date Nov 29, 2018
Publicly Available Date Mar 1, 2019
Journal Open Heart
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 1
Article Number e000975
DOI https://doi.org/10.1136/openhrt-2018-000975
Keywords acute coronary syndrome, treatment time, treatment interventions,
Public URL http://researchrepository.napier.ac.uk/Output/1401788
Contract Date Mar 1, 2019

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Copyright Statement
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0








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