Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions

被引:7
作者
Nesoff, Elizabeth D. [1 ]
Brownstein, J. Nell [2 ]
Veazie, Mark [3 ]
O'Leary, Marcia [4 ]
Brody, Eric A. [5 ]
机构
[1] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Behav & Soc, 624 N Broadway, Baltimore, MD 21205 USA
[2] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Heart Dis & Stroke Prevent, 4770 Buford Highway NE,Mailstop F-72, Atlanta, GA 30341 USA
[3] Indian Hlth Serv, 1215 N Beaver St,Suite 201, Flagstaff, AZ 86001 USA
[4] Missouri Breaks Ind Res, HCR 64 Box 52, Timber Lake, SD 57656 USA
[5] Univ Arizona, Med Ctr, Native Amer Cardiol & Med Serv Program, 1501 North,Campbell Ave,POB 245202, Tucson, AZ 85724 USA
关键词
American Indians; Myocardial infarction; Time-to-treatment delay; Qualitative research; HEART-DISEASE MORTALITY; RISK-FACTORS; HISTORICAL TRAUMA; HEALTH-PROMOTION; UNITED-STATES; DELAY; NATIVES; CARE; INTERVENTION; PATTERNS;
D O I
10.1007/s10900-016-0239-x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.
引用
收藏
页码:129 / 138
页数:10
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