OBJECTIVE: This paper identified barriers which prevent rural health care providers from utilising rt-PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. METHODS: This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute stroke patient care in three rural hospitals with rt-PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt-PA use in acute stroke. RESULTS: Physicians reported the strongest barriers to the use of rt-PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage (ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt-PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt-PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. CONCLUSIONS: To reduce barriers to rt-PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose stroke patients who are eligible for rt-PA treatment. Education for nurses on symptoms of stroke and rt-PA utilisation and administration is recommended.
OBJECTIVE: This paper identified barriers which prevent rural health care providers from utilising rt-PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. METHODS: This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute strokepatient care in three rural hospitals with rt-PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt-PA use in acute stroke. RESULTS: Physicians reported the strongest barriers to the use of rt-PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage (ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt-PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt-PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. CONCLUSIONS: To reduce barriers to rt-PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose strokepatients who are eligible for rt-PA treatment. Education for nurses on symptoms of stroke and rt-PA utilisation and administration is recommended.
Authors: Leonard Baatiema; Michael Otim; George Mnatzaganian; Ama De-Graft Aikins; Judith Coombes; Shawn Somerset Journal: BMC Health Serv Res Date: 2017-02-02 Impact factor: 2.655
Authors: Leonard Baatiema; Ama de-Graft Aikins; Adem Sav; George Mnatzaganian; Carina K Y Chan; Shawn Somerset Journal: BMJ Open Date: 2017-04-27 Impact factor: 2.692
Authors: Leonard Baatiema; Michael E Otim; George Mnatzaganian; Ama de-Graft Aikins; Judith Coombes; Shawn Somerset Journal: Implement Sci Date: 2017-06-05 Impact factor: 7.327