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Open Access 01-12-2011 | Research article

Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study

Authors: William J Meurer, Jennifer J Majersik, Shirley M Frederiksen, Allison M Kade, Annette M Sandretto, Phillip A Scott

Published in: BMC Emergency Medicine | Issue 1/2011

Abstract

Background

Only 1-3% of ischemic stroke patients receive thrombolytic therapy. Provider barriers to adhering with guidelines recommending tPA delivery in acute stroke are not well known. The main objective of this study was to describe barriers to thrombolytic use in acute stroke care.

Methods

Twenty-four hospitals were randomly selected and matched into 12 pairs. Barrier assessment occurred at intervention sites only, and utilized focus groups and structured interviews. A pre-specified taxonomy was employed to characterize barriers. Two investigators independently assigned themes to transcribed responses. Seven facilitators (three emergency physicians, two nurses, and two study coordinators) conducted focus groups and interviews of emergency physicians (65), nurses (62), neurologists (15), radiologists (12), hospital administrators (12), and three others (hospitalists and pharmacist).

Results

The following themes represented the most important external barriers: environmental and patient factors. Important barriers internal to the clinician included familiarity with and motivation to adhere to the guidelines, lack of self-efficacy and outcome expectancy. The following themes were not substantial barriers: lack of awareness of the existence of acute stroke guidelines, presence of conflicting guidelines, and lack of agreement with the guidelines.

Conclusions

Healthcare providers perceive environmental and patient-related factors as the primary barriers to adherence with acute stroke treatment guidelines. Interventions focused on increasing physician familiarity with and motivation to follow guidelines may be of highest yield in improving adherence. Improving self-efficacy in performing guideline concordant care may also be useful.

Trial Registration

ClinicalTrials.gov identifier: NCT00349479

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-227X/11/5/prepub

Title: Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study
Authors: William J Meurer
Jennifer J Majersik
Shirley M Frederiksen
Allison M Kade
Annette M Sandretto
Phillip A Scott
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: BMC Emergency Medicine / Issue 1/2011
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/1471-227X-11-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study

Abstract

Background

Methods

Results

Conclusions

Trial Registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial Registration

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