Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: An audit of current practice and clinical outcomes

Abstract

Recombinant tissue plasminogen activator can be delivered in rural Australian hospitals in a timely manner within recommended implementation guidelines. Acute stroke thrombolytic services in rural Australian facilities had comparable outcomes to metropolitan facilities. Small numbers of thrombolysed patients prevented a validation study of the well-defined outcome benefits from rt-PA. The need for ongoing data collection in regional settings is supported.

Who does it first? The uptake of medical innovations in the performance of thrombolysis on ischemic stroke patients in Germany: a study based on hospital quality data

“…The same applies to a hospital’s location: hospitals in urban regions were no more likely to perform systemic thrombolysis than hospitals in rural regions. These findings correspond with the results from an Australian study [ 32 ]. The question as to why hospitals with between 500 and 1,000 beds were less likely to have implemented systemic thrombolysis as early as 2006 needs to be addressed through further research.…”

“…Because the implementation process is influenced by many factors [ 23 ], the question also has to be raised regarding the extent to which these factors are influenced by specific national characteristics. Several studies have shown the effect the organizational level has on the implementation of guidelines, with similar results having been obtained across different national settings [ 24 - 32 ]. With this in mind, we focused on organizational level parameters that can be compared on an international scale: ownership, hospital location, hospital size, teaching status, and the existence of a stroke unit.…”

“…The implementation of systemic thrombolysis in acute ischemic stroke care can reduce the burden of stroke [ 38 ]. Although systemic thrombolysis remains the only approved curative and causal treatment [ 5 ] to date, many countries around the world still struggle with a thrombolysis rate below the possible optimum [ 32 , 39 ], as well as with the fact that hospitals do treat acute stroke patients but not by performing systemic thrombolysis [ 35 ]. It is therefore necessary to identify possible barriers on the organizational level that prevent the implementation of thrombolysis in acute ischemic stroke care.…”

“…In addition, non-university hospitals in Sweden took 2–3 years longer to implement thrombolysis, with such hospitals not recording thrombolysis rates similar to university hospitals until 2008 [ 31 ]. With regard to a hospital’s location, rural hospitals in Australia seem to have the same thrombolysis rate as hospitals located in metropolitan regions [ 32 ].…”

Economic Evaluation of a Pre-Hospital Protocol for Patients with Suspected Acute Stroke

“…However, the reported national averages mask the extent of geographical variation in implementation. The few reports available from regional hospitals suggest that access to tPA for stroke in the smaller regional and rural locations can be minimal to non-existent ( 8 , 9 ). In such situations, new models of care are needed to improve both pre-hospital assessment for potential tPA eligibility and the time between stroke event and treatment in a specialized stroke center.…”