title: Provision of stroke thrombolysis services in New Zealand: changes between 2011 and 2016.
abstract: OBJECTIVE
  To obtain an overall picture of the organisation of stroke thrombolysis provision in New Zealand hospitals and compare changes between 2011 and 2016.
  
  
  METHODS
  Surveys were distributed to all New Zealand district health boards (DHBs) in 2011 and 2016, and included questions about the infrastructure, staffing, training, guidelines and audit provided for stroke thrombolysis.
  
  
  RESULTS
  Responses were received from all DHBs, with 86% offering stroke thrombolysis in 2011 and 100% in 2016. In 2016, thrombolysis rosters of large DHBs (those with a population >250,000 people) had a mean (range) of 14 (5-34) clinicians, approximately double that of medium-sized DHBs (population 125-250,000) who had eight (3-15) and small DHBs (population <125,000) with seven, (2-13) clinicians. While a similar distribution of senior medical officer clinical specialty was seen across medium and small DHBs in both years, large DHBs in 2016 had a higher number of neurologists (5, 1-12) and an increasing number of general physicians (8, 0-30) rostered to provide thrombolysis compared to 2011. Thrombolysis services at medium and small DHBs are chiefly managed by general physicians and geriatricians, while telestroke support was only available in three medium-sized DHBs. In 2016, all hospitals had developed thrombolysis guidelines and audited thrombolysed patients in the National Stroke Thrombolysis Register, which is an improvement compared with 2011 when only seven (39%) DHBs reported regular audit. Challenges in staffing and training remain greatest in smaller and geographically isolated DHBs.
  
  
  CONCLUSIONS
  While there have been improvements in the provision of stroke thrombolysis throughout New Zealand, regional variations in service quality remains. The needs for better solutions to geographical barriers and formal training must be addressed as priorities.
authors.affiliation: Trainee Intern, Departments of Neurology, Auckland City Hospital and University of Auckland.
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Neurologist and National Clinical Leader Stroke, Department of Neurology, Wellington Regional Hospital and University of Otago.
authors.forename: Annemarei Anna
authors.initials: AA
authors.lastname: Ranta
authors.affiliation: National Stroke Network Coordinator, Stroke Foundation of New Zealand.
authors.forename: Ginny
authors.initials: G
authors.lastname: Abernethy
authors.affiliation: Professor, Neurologist and Stroke Service Clinical Lead, Department of Neurology, Auckland City Hospital and University of Auckland, Auckland.
authors.forename: P Alan
authors.initials: PA
authors.lastname: Barber
mesh_terms: D039602:After-Hours Care / Q000639:trends; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D058005:General Practitioners / Q000193:education / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000458:organization & administration / Q000639:trends*; D006767:Hospitals, District / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D008485:Medical Audit / Q000639:trends; D008505:Medical Staff, Hospital / Q000193:education / Q000458:organization & administration* / Q000639:trends; D000072141:Neurologists / Q000193:education / Q000600:supply & distribution; D009520:New Zealand; D016134:Organizational Policy; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D017216:Telemedicine / Q000639:trends
chemical_list: D005343:Fibrinolytic Agents