title: Organisational barriers to thrombolysis treatment of acute ischaemic stroke.
abstract: BACKGROUND
  Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in any country although the treatment is both effective and cost-effective in selected patients within a 3-h window after acute ischaemic stroke. The purpose of the present study was to describe the organisational barriers to delivery of thrombolysis for acute ischaemic stroke with special regard to the Danish healthcare system.
  
  
  METHODS
  Systematic and unsystematic searches of medical, economic and grey literature on organisational barriers to thrombolysis treatment were performed in Cochrane, PubMed, EMBASE, Cinahl, Econlit, NHS EED, SvedMed+ and the Health Technology Assessment (HTA) database. The search periods were 1996-2006.
  
  
  RESULTS
  Three main types of literature on organisational barriers were found: medical literature including HTA reports on barriers related to the 3-h window, economic literature on barriers related to the lack of capacity to provide the treatment on a 24-h basis, and grey literature/policy papers on standards and demands to the hospitals and healthcare systems who implements the treatment.
  
  
  CONCLUSIONS
  Information on organisational barriers can be extracted from different types of literature (medical, economic and grey literature/policy papers), but organisational barriers are most often not the primary study objective in the relevant literature. This review showed a broad spectrum of possible organisational barriers to the delivery of thrombolysis treatment of acute ischaemic stroke.
authors.affiliation: HTA Unit, Aarhus University Hospital, Denmark. lars.ehlers@stab.rm.dk
authors.forename: Lars
authors.initials: L
authors.lastname: Ehlers
authors.forename: Lotte Groth
authors.initials: LG
authors.lastname: Jensen
authors.forename: Merete A
authors.initials: MA
authors.lastname: Bech
authors.forename: Grethe
authors.initials: G
authors.lastname: Andersen
authors.forename: Mette
authors.initials: M
authors.lastname: Kjølby
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D003718:Denmark; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents