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

Barbara Farquharson (Lead / Corresponding author), Purva Abhyankar, Karen Smith, Stephan U. Dombrowski, Shaun Treweek, Nadine Dougall, Brian Williams, Marie Johnston

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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.

Trial registration number: CRD42014013106.

Original languageEnglish
Article numbere000975
Pages (from-to)1-19
Number of pages19
JournalOpen Heart
Volume6
Issue number1
DOIs
Publication statusPublished - 27 Feb 2019

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Acute Coronary Syndrome
Outcome Assessment (Health Care)
Information Storage and Retrieval
Controlled Clinical Trials
MEDLINE
Libraries
Nursing
Cohort Studies
Therapeutics
Randomized Controlled Trials
Mortality
Health

Keywords

  • acute coronary syndrome
  • delay: Behaviour change
  • education
  • psychology

Cite this

Farquharson, Barbara ; Abhyankar, Purva ; Smith, Karen ; Dombrowski, Stephan U. ; Treweek, Shaun ; Dougall, Nadine ; Williams, Brian ; Johnston, Marie. / 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. In: Open Heart. 2019 ; Vol. 6, No. 1. pp. 1-19.
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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 (Lead / Corresponding author); Abhyankar, Purva; Smith, Karen; Dombrowski, Stephan U.; Treweek, Shaun; Dougall, Nadine; Williams, Brian; Johnston, Marie.

In: Open Heart, Vol. 6, No. 1, e000975, 27.02.2019, p. 1-19.

Research output: Contribution to journalArticle

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T1 - Reducing delay in patients with acute coronary syndrome and other time-critical conditions

T2 - A systematic review to identify the behaviour change techniques associated with effective interventions

AU - Farquharson, Barbara

AU - Abhyankar, Purva

AU - Smith, Karen

AU - Dombrowski, Stephan U.

AU - Treweek, Shaun

AU - Dougall, Nadine

AU - Williams, Brian

AU - Johnston, Marie

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N2 - 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.Trial registration number: CRD42014013106.

AB - 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.Trial registration number: CRD42014013106.

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