Trial reportBMC emergency medicine2011
Provider perceptions of barriers to the emergency use of tPA for acute ischemic stroke: a qualitative study.
Trial report in BMC emergency medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00349479 (Clinical Trial to Increase t-PA Use in Stroke Treatment), which is not on this map. Cited by 37 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Clinical Trial to Increase t-PA Use in Stroke Treatment
Who cites it
37 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2026Pooled it
- Extrinsic and intrinsic factors acting as barriers or facilitators in nurses' implementation of clinical practice guidelines: a mixed-method systematic review.Acta bio-medica : Atenei Parmensis · 2022Pooled it
- Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review.Implementation science : IS · 2017Pooled it
- Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF).Implementation science : IS · 2016Pooled it
- Pooled it
- Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2015Pooled it
- Can a multicomponent multidisciplinary implementation package change physicians' and nurses' perceptions and practices regarding thrombolysis for acute ischemic stroke? An exploratory analysis of a cluster-randomized trial.Implementation science : IS · 2019Trial
- A multilevel intervention to increase community hospital use of alteplase for acute stroke (INSTINCT): a cluster-randomised controlled trial.The Lancet. Neurology · 2013Trial
- External validation of machine learning models for predicting prehospital delay in acute ischemic stroke: a retrospective cohort study.Frontiers in neurology · 2026Article
- Modelling the potential clinical benefit of mobile stroke units in England.BMC emergency medicine · 2025Article
- Understanding healthcare providers' perspectives on barriers to accessing stroke care at a resource-limited hospital in East Africa: A qualitative study from Mnazi Mmoja Referral Hospital in Zanzibar.PLOS global public health · 2025Article
- Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers' perspective.BMC health services research · 2024Article
- Analyzing the barriers and enablers to internet hospital implementation: a qualitative study of a tertiary hospital using TDF and COM-B framework.Frontiers in digital health · 2024Article
- Knowledge on Stroke Recognition and Management among Emergency Department Healthcare Professionals in the Republic of Cyprus.Healthcare (Basel, Switzerland) · 2023Article
- Article
- Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Observational
- A Case for the Non-Neurologist Telestroke Provider.Frontiers in neurology · 2021Article
- Expanding Acute Stroke Care in Rural America: A Model for Statewide Success.Telemedicine journal and e-health : the official journal of the American Telemedicine Association · 2020Article
- Health care providers' perceptions of factors that influence the provision of acute stroke care in urban and rural settings: A qualitative study.SAGE open medicine · 2020Article
- Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundOnly 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.
methodsTwenty-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).
resultsThe 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.
conclusionsHealthcare 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.
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