Patients’ and ambulance service clinicians’ experiences of prehospital care for acute myocardial infarction and stroke: a qualitative study Fiona Jayne Togher, 1 Zowie Davy, 1 Aloysius Niroshan Siriwardena 1,2 1 Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK 2 East Midlands Ambulance Service, NHS Trust, Lincolnshire Divisional Headquarters, Lincoln, UK Correspondence to Fiona Jayne Togher, School of Health and Social Care, Faculty of Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK; ftogher@lincoln.ac.uk Accepted 30 September 2012 ABSTRACT Background Patients with suspected acute myocardial infarction (AMI) and stroke commonly present first to the ambulance service. Little is known about experiences of prehospital care which are important for measuring the quality of services for patients with AMI or stroke. Aim We explored experiences of patients, who had accessed the ambulance service for AMI or stroke, and clinicians regularly treating patients for these conditions in the prehospital setting. Method A qualitative research design was employed to obtain rich and detailed data to explore and compare participants’ experiences of emergency prehospital care for AMI and stroke. Results We conducted 33 semistructured interviews with service users and clinicians and one focus group with five clinicians. Four main themes emerged: communication, professionalism, treatment of condition and the transition from home to hospital. Patients focused on both personal and technical skills. Technical knowledge and relational skills together contributed to a perception of professionalism in ambulance personnel. Patients’ experience was enhanced when physical, emotional and social needs were attended to and they emphasised effective communication within the clinician–patient relationship to be the key. However, we found a discrepancy between paramedics’ perceptions of patients’ expectations and patients’ lack of knowledge of the paramedic role. Conclusions Factors that contribute to better patient experience are not necessarily understood in the same way by patients and clinicians. Our findings can contribute to the development of patient experience measures for prehospital care. INTRODUCTION Cardiovascular disease is the most common cause of death in the UK accounting for almost two-thirds of premature deaths. The annual inci- dence of acute myocardial infarction (AMI) is esti- mated to be 268 000 cases 1 and stroke 150 000 cases. 2 People suffering from cardiovascular disease often present acutely to ambulance services with symptoms of AMI or stroke and therefore patients’ experiences and outcomes of prehospital care are important for measuring the quality of services. Patient reported experience measures (PREMs) are increasingly being seen as important tools by healthcare providers, commissioners, regulators and service users. These are usually short, self- completion patient questionnaires which measure experience of care at a point in time. 3 Despite the introduction of PREMs to the NHS, 45 there are few validated PREMs for specific conditions, such as stroke and AMI, currently in use or under development for use in prehospital care and, therefore, this is an area for further research and development. To contribute to this process, we aimed to gather data on the views of patients accessing the ambulance service and clinicians treating patients to compare concordance and dissonance in the views of both groups. METHOD We used a qualitative design, interviewing partici- pants who had received or provided prehospital clinical care in the East Midlands, UK. We decided to interview clinicians because we also wanted to understand what aspects of care they considered important for patients’ well-being. Any key differ- ences highlighted between patient and clinician perspectives would provide the rationale for important additions to paramedic education and training. We wished to obtain rich and detailed data in order to explore and compare the partici- pants’ experiences of prehospital care for suspected stroke or suspected AMI. We used purposive sampling for patients and clinicians. Patients were recruited using postal invi- tations from general practices, waiting room posters and leaflets. To be eligible for inclusion, patients were required to have experienced prehos- pital emergency care for suspected AMI or stroke within the previous 12 months. Patients completed a demographic questionnaire before the interview asking about their age, sex, ethnicity and medical condition. Clinicians were purposively recruited following the distribution of participant information packs across a number of ambulance stations in the East Midlands. We collected demographic data from clin- icians about their job role, length of time in their current role and length of service as a clinician. Patients and clinicians were given the option to be interviewed individually or in a focus group. Contributions made by the participant’s partner (or carer) provided a valuable additional dimension to the data collection. Data collection took place between February and December 2011. Data were analysed using a thematic network approach 6 supported by NVivo 8. A coding frame was developed based on questions included within the interview schedules. This was modified follow- ing thorough immersion in the text to produce themes and subthemes. The thematic networks Emerg Med J 2012;0:1–7. doi:10.1136/emermed-2012-201507 1 Original article EMJ Online First, published on November 8, 2012 as 10.1136/emermed-2012-201507 Copyright Article author (or their employer) 2012. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on November 16, 2012 - Published by emj.bmj.com Downloaded from