Abstract

The problem: Current health policy emphasises patient experience, together with effectiveness and safety, as key components of quality of care. As a consequence, Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are increasingly being seen as important, whether by providers, commissioners, regulators or service users themselves for assessing quality of care; by researchers for evaluating the outcomes of specific interventions; and also by clinicians for assessment and decision support.
Patients with suspected acute myocardial infarction (AMI) or stroke commonly present first to the ambulance service rather than general practice. Little is known about outcomes and experiences of pre-hospital care which are important for measuring the quality of services for patients with AMI or stroke.
There are few validated PROMs in use within prehospital care including for conditions such as AMI or stroke
The approach: Guidance around the development of PROMs suggests that items for inclusion within the questionnaires can be generated from stakeholders including service users. We decided to utilise a qualitative research design to explore the experiences of patients and ambulance service clinicians for emergency care of stroke or heart attack in the pre-hospital setting.
Thirty four semi-structured interviews (22 with patients, 12 with clinicians) and one focus group (5 clinicians) were conducted using a predetermined interview schedule designed to elicit participants’ views on clinical outcome and patient experience elements of prehospital care.
Data were analysed using a thematic network approach supported by Nvivo 8 software. A coding frame was initially developed based on the questions included within the interview schedule. This was then modified following thorough immersion in the text to produce the final themes. The thematic networks were discussed and refined by all three authors. The analyses of clinician and patient data were untaken together as one data set to facilitate the comparison, connections and disjuncture of experiences.
Findings: Patients, regardless of their medical condition, often considered the same factors as essential to a good pre-hospital experience. They focused on both personal and technical skills of the clinician emphasising effective communication and the clinician-patient relationship. The most important themes that emerged from the patient perspective were; communication, holistic care and professionalism. The remaining themes of treatment of condition and transitions were more regularly discussed by clinicians.
Consequences: Within the evaluation and improvement of health care services the development of PROMs and PREMs will continue to be important and the methods used in this study within the context of prehospital care may be transferrable to other health care settings such as primary and acute care. Utilising a qualitative research design enabled us to obtain a more informed understanding of the outcomes and experiences that patients attach greatest importance to as well as understanding how these corresponded with the views of clinicians.