Chest
Volume 113, Issue 2, February 1998, Pages 297-305
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Clinical Investigations: Cardiology
Comparative Knowledge and Practice of Emergency Physicians, Cardiologists, and Primary Care Practitioners Regarding Drug Therapy for Acute Myocardial Infarction

https://doi.org/10.1378/chest.113.2.297Get rights and content

Objectives

This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners.

Background

Debate surrounding the respective roles of emergency physicians, primary care practitioners, and specialists figures prominently in discussions regarding the nation's evolving health-care system. Data are lacking about the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding conditions commonly treated by all three groups, eg, AMI.

Methods

A survey of 1,045 emergency physicians, nationally, was conducted in 1995 regarding five short-term pharmacologic interventions employed for many years in the standard treatment of AMI. The emergency physicians were questioned about the effect on survival of each intervention and the likelihood that they would prescribe each intervention. The findings were then compared with previously published data on the knowledge and practice of cardiologists and primary care practitioners obtained in New York and Texas in 1993. Identical clinical queries and eligibility criteria were employed in all groups.

Results

The responding emergency physicians' knowledge was similar or significantly greater than that of responding cardiologists for the effect on survival of most of the short-term interventions, and their practice patterns were similar or significantly better than responding cardiologists for all interventions studied. Emergency physicians and cardiologists had significantly better knowledge and practice in this area compared with responding primary care practitioners.

Conclusions

For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.

Section snippets

Study Population

This study was conducted nationally in order to obtain a sufficient number of participants from April through September 1995. In the first phase of survey distribution, telephone contact with the program or research director of each of the nation's 104 approved emergency medicine residency training programs30 was attempted to obtain the number of emergency medicine board-eligible or board-certified physicians on each program's faculty. Successful contact was made with 93 (89.4%) of the

Demographic Characteristics of the Physicians

Questionnaires (1,045) were returned by eligible physicians; 564 (54%) came from the emergency medicine faculty group, 481 (46%) came from the nonfaculty group, and 181 came from ineligible physicians; this yielded an estimated eligibility rate of 85% (in both groups) and an overall response rate of 55% among eligible emergency physicians (57.4% of the faculty group and 52.1% of the nonfaculty group). The comparison of the characteristics of the emergency physicians with those of the study

Discussion

Most patients presenting for treatment of acute myocardial infarction (AMI) are treated by emergency physicians in hospital emergency departments.26, 27, 28 This study was undertaken to assess the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding the standard of care for the emergency department drug therapy for AMI. Ayanian et al29 had previously surveyed internists, family practitioners, and cardiologists. Using the same study

Conclusion

Within the context of this study, emergency physicians, on average, have a similar or significantly better knowledge and practice of most short-term pharmacologic interventions in the setting of AMI than cardiologists, and both groups, on average, have a superior knowledge and practice in this area than primary care practitioners. The treatment of patients with AMI, based on evidenced-based medical practice, is one of the quintessential examples of the function and purpose of the emergency

ACKNOWLEDGMENTS

The authors would like to acknowledge John Z. Ayanian, MD, MPP, Department of Health Care Policy, Harvard Medical School, for the use of his study instrument and his contributions to the data analysis and manuscript preparation; Pamela Williams-Russo, MD, MPH, Clinical Epidemiology Unit of the Department of Medicine, Cornell University Medical Center-New York Hospital, for her contributions to data analysis and presentation and manuscript preparation; and Neal Shipley, MD, Center for Emergency

References (42)

  • WhiteBC et al.

    Macy Foundation report on emergency medicine

    Ann Emerg Med

    (1995)
  • The Access to Emergency Medical Services Act. HR...
  • Heart facts

    (1988)
  • Health, United States

    (1990)
  • GravesEJ

    1991 summary: national hospital discharge survey

    (1993)
  • The TIMI study group: special report—the thrombolysis in myocardial infarction (TIMI) Trial

    N Engl J Med

    (1985)
  • WhiteHD et al.

    Effect of intravenous streptokinase on left ventricular function and yearly survival after myocardial infarction

    N Engl J Med

    (1987)
  • MeinertzT et al.

    The German multicenter trial of anisoylated plasminogen-streptokinase activator complex versus heparin in acute myocardial infarction

    Am J Cardiol

    (1989)
  • RappaportE

    Thrombolytic agents in acute myocardial infarction

    N Engl J Med

    (1989)
  • Comparison of invasive conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the thrombolysis in myocardial infarction (TIMI) phase II trial

    N Engl J Med

    (1985)
  • LauJ et al.

    Cumulative meta-analysis of therapeutic trials for myocardial infarction

    N Engl J Med

    (1992)
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    The survey was distributed directly from and entirely funded by the Department of Emergency Medicine of New York Methodist Hospital, Brooklyn. The statistical analyses and manuscript preparation took place at the Department of Emergency Medicine of New York Methodist Hospital and the Clinical Epidemiology Unit of the Department of Medicine of the Cornell University Medical Center-New York Hospital, New York.

    revision accepted July 14, 1997.

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