title: Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: a survey of barriers and enablers.
abstract: 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.
authors.affiliation: Acute Stroke Unit, Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia.
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Williams
authors.forename: Martin R
authors.initials: MR
authors.lastname: Jude
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Levi
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000188:drug therapy*; D003657:Decision Making; D004363:Drug Utilization / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator
chemical_list: D010959:Tissue Plasminogen Activator
keywords: decision making; emergency medicine; obstacle; physician; thrombolytic therapy