Recombinant tissue plasminogen activator (rt‐<scp>PA</scp>) utilisation by rural clinicians in acute ischaemic stroke: A survey of barriers and enablers

Williams, Jocelyn M.; Jude, Martin; Levi, Christopher

doi:10.1111/ajr.12052

Cited by 15 publications

(28 citation statements)

References 19 publications

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“…Three qualitative [60–62] and seven quantitative studies [63–69] were included. Quantitative studies employed online and postal surveys while the qualitative studies used semi-structured interviews and focus group methods.…”

Section: Resultsmentioning

confidence: 99%

“…Included studies were published between 2004 and 2015. Four studies were conducted in Australia [62, 64, 66, 69], three in the USA [60, 63, 65], two in Sweden [61, 67], and one each in Norway [67], Denmark [67] and the Netherlands [68]. Most of the barriers or enablers identified in the quantitative studies were also found in the qualitative studies.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the barriers or enablers identified in the quantitative studies were also found in the qualitative studies. Studies predominantly examined the barriers or enablers to the use of thrombolysis [60, 61, 63–65, 67, 69]. One study focused exclusively on barriers related to the establishment of a stroke unit [66], another on the uptake of both aspirin and thrombolysis [68] and the remaining on stroke unit and thrombolysis [62].…”

Section: Resultsmentioning

confidence: 99%

“…Only one study described in detail the sampling of study subjects and employed sampling techniques to minimise selection bias [69]. However, the rest of the cross sectional studies did not include substantive information on sampling techniques used to minimise selection bias.…”

Section: Resultsmentioning

confidence: 99%

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Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review

et al. 2017

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BackgroundAdoption of contemporary evidence-based guidelines for acute stroke management is often delayed due to a range of key enablers and barriers. Recent reviews on such barriers focus mainly on specific acute stroke therapies or generalised stroke care guidelines. This review examined the overall barriers and enablers, as perceived by health professionals which affect how evidence-based practice guidelines (stroke unit care, thrombolysis administration, aspirin usage and decompressive surgery) for acute stroke care are adopted in hospital settings.MethodologyA systematic search of databases was conducted using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Cochrane Library and AMED (Allied and Complementary Medicine Database from 1990 to 2016. The population of interest included health professionals working clinically or in roles responsible for acute stroke care. There were no restrictions to the study designs. A quality appraisal tool for qualitative studies by the Joanna Briggs Institute and another for quantitative studies by the Centre for Evidence-Based Management were used in the present study. A recent checklist to classify barriers and enablers to health professionals’ adherence to evidence-based practice was also used.ResultsTen studies met the inclusion criteria out of a total of 9832 search results. The main barriers or enablers identified included poor organisational or institutional level support, health professionals’ limited skills or competence to use a particular therapy, low level of awareness, familiarity or confidence in the effectiveness of a particular evidence-based therapy, limited medical facilities to support evidence uptake, inadequate peer support among health professionals’, complex nature of some stroke care therapies or guidelines and patient level barriers.ConclusionsDespite considerable evidence supporting various specific therapies for stroke care, uptake of these therapies is compromised by barriers across organisational, patients, guideline interventions and health professionals’ domains. As a result, we recommend that future interventions and health policy directions should be informed by these findings in order to optimise uptake of best practice acute stroke care. Further studies from low- to middle-income countries are needed to understand the barriers and enablers in such settings.Trial registrationThe review protocol was registered in the international prospective register of systematic reviews, PROSPERO 2015 (Registration Number: CRD42015023481)Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0599-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review

et al. 2017

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“…However, the lack of rapid diagnostic testing hinders patient management. Although an effective ischemic stroke treatment is available, tissue-type plasminogen activator, 3 studies have observed an underuse by rural 4 and emergency physician 5,6 owing, in part, to diagnostic uncertainty, risk of hemorrhage, and the short therapeutic time window. However, a biomarker that establishes diagnosis of stroke and distinguishes hemorrhage from ischemia has the potential to minimize the time from symptom onset to treatment and improve patient outcomes.…”

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confidence: 99%

Peripheral Blood MCEMP1 Gene Expression as a Biomarker for Stroke Prognosis

Raman

O’Donnell

Członkowska

et al. 2016

Stroke

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−4). MCEMP1 was also highest soon after symptom onset and had no association with stroke risk factors. Furthermore, MCEMP1 expression independently improved discrimination of 1-month outcome. Indeed, discrimination models for disability and mortality that included MCEMP1 expression, baseline modified Rankin Scale score, and primary stroke type improved discrimination when compared with a model without MCEMP1 (disability Net Reclassification Index, 0.76; P=3.0×10 −6 and mortality Net Reclassification Index, 1.3; P=1.1×10). Significant associations with MCEMP1 were confirmed in an independent validation cohort of 28 stroke cases and 34 controls. Conclusions-This study demonstrates that peripheral blood expression of MCEMP1 may have utility for stroke diagnosis and as a prognostic biomarker of stroke outcome at 1-month. (Stroke. 2016;47:652-658.

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Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

et al. 2017

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ObjectiveDespite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings.DesignA qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes.SettingA multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana.ParticipantsA total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian.ResultsFour key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals.ConclusionBarriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.

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Recombinant tissue plasminogen activator (rt‐PA) utilisation by rural clinicians in acute ischaemic stroke: A survey of barriers and enablers

Cited by 15 publications

References 19 publications

Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review

Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review

Peripheral Blood MCEMP1 Gene Expression as a Biomarker for Stroke Prognosis

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

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