Screening for Atrial Fibrillation – A Cross-Sectional Survey of Healthcare Professionals in Primary Care

Introduction
Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting.
Methods
A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis.
Results
At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator.
Conclusion
Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care.

引言
初级保健领域的心房颤动（AF）筛查已被推荐，但目前尚不明确医疗保健专业人员（HCPs）对此的态度。本研究旨在探究HCPs对于在初级保健环境中开展AF筛查的可行性看法。

研究方法
本研究于2014年10月至12月期间，针对英国诺丁汉59个市区基层医疗机构的418名医疗保健专业人员（HCPs）开展了横断面混合方法普查调查。通过邮寄问卷与网络问卷，结合李克特量表与开放式问题，收集了关于AF筛查现有方法、相关知识、技能、态度、障碍及促进因素的数据。研究按HCP群体对回收问卷进行分类，采用比例法总结数据，并通过校正医疗机构聚类效应计算95%置信区间（CI）；同时采用主题分析法对自由文本回复进行分析。

研究结果
共有48家（81%）基层医疗机构至少回收了1份全科医生（GP）问卷。本次调查共回收有效问卷212份，总回收率为51%（212/418），其中全科医生问卷118份（229名GP中回收118份）、护士问卷67份（129名护士中回收67份，含50名基层护士与17名执业护士（NPs））、医疗辅助人员（HCAs）问卷27份（60名HCAs中回收27份）。48家医疗机构中有39家（81%）配备了心电图机（ECG），可在机构内完成AF诊断。非GP类HCPs表示，其在ECG解读、AF诊断与治疗相关知识方面的掌握程度弱于全科医生。相较于全科医生，更多比例的非GP类HCPs认为接受针对AF诊断的ECG专项培训可使自身获益[比例（95% CI）：全科医生11.9%（6.8~20.0）；HCAs 37.0%（21.7~55.5）；护士44.0%（30.0~59.0）；执业护士41.2%（21.9~63.7）]。本次调查识别的筛查障碍包括时间不足、工作负荷过重与筛查开展能力受限，而AF诊断与管理相关培训则是必要的促进实施的因素。

研究结论
本次研究显示，市区基层医疗机构具备开展AF筛查所需的充足资源。非GP类HCPs对提升AF诊断与管理相关技能表现出积极意愿，未来或可在AF筛查工作中发挥作用。但若要在初级保健环境中切实可行地开展AF筛查，仍需克服诸如时间匮乏、人员不足与能力受限等组织层面的障碍。