The number of stroke physicians is the key to preparing IV rt-PA.
BACKGROUND
Our aim was to investigate the relationship between the number of stroke physicians (SPs) and management of intravenous thrombolysis using recombinant tissue plasminogen activator (IV rt-PA) in Japan.


METHODS
Questionnaires about the infrastructure of acute-stroke care were sent to 1,466 hospitals that treated acute-stroke patients in September 2007. The responses were categorized as follows: (1) established or ineligible for IV rt-PA before September 2007, and discontinued or starting IV rt-PA from October 2007 to September 2008; (2) total number of SPs in those hospitals; (3) infrastructures according to acute-stroke treatment. Components related to discontinuing or starting IV rt-PA were analyzed.


RESULTS
Responses were received from 1,025 hospitals. Of these, 950 hospitals were continuing administration to acute-stroke patients, but 75 had discontinued administration. Before September 2007, 466 hospitals had already established administration of IV rt-PA (rt-PA hospitals) after government approval of IV rt-PA (non-rt-PA hospitals). From October 2007 to September 2008, 45 of 466 rt-PA hospitals (9.7%) discontinued IV rt-PA, while 29 of 479 (6.1%) non-rt-PA hospitals started. Less than 3 SPs were present in 73.9% of the 45 discontinued IV rt-PA hospitals and 37.9% of the 29 starting hospitals. In multivariate analysis, discontinuing IV rt-PA was inversely associated with > or =3 SPs (odds ratio = 0.37; 95% confidence interval = 0.15-0.87; p = 0.023). Factors associated with starting IV rt-PA were > or =3 SPs (OR = 6.19; 95% CI = 2.01-19.08; p = 0.002).


CONCLUSIONS
The number of SPs available may contribute to the management of rt-PA hospitals.
Iguchi
Yasuyuki
Y
Department of Stroke Medicine, Kawasaki Medical School, Okayama, Japan. yigu@med.kawasaki-m.ac.jp
Kimura
Kazumi
K
Shibazaki
Kensaku
K
Aoki
Junya
J
D004363:Drug Utilization; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous; D007564:Japan / Q000453:epidemiology; D010820:Physicians / Q000600:supply & distribution*; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D012044:Regression Analysis; D020521:Stroke / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator