Attitudes and Beliefs of Michigan Emergency Physicians Toward Tissue Plasminogen Activator Use in Stroke
- 1 September 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 41 (9), 2026-2032
- https://doi.org/10.1161/strokeaha.110.581942
Abstract
Background and Purpose— The objective of this study was to determine the baseline proportion of emergency physicians with favorable attitudes and beliefs toward intravenous tissue plasminogen activator (tPA) use in a cohort of randomly selected Michigan hospitals. Methods— Two hundred seventy-eight emergency physicians from 24 hospitals were surveyed. A confidential, self-administered, pilot-tested survey assessing demographics, practice environment, attitudes, and beliefs regarding tPA use in stroke was used. Main outcome measures assessed belief in a legal standard of care, likelihood of use in an ideal setting, comfort in use without a specialist consultation, and belief that science on tPA use is convincing. ORs with robust 95% CIs (adjusted for clustering) were calculated to quantify the association between responses and physician- and hospital-level characteristics. Results— One hundred ninety-nine surveys completed (gross response rate 71.6%). Ninety-nine percent (95% CI: 97.8 to 100) indicated use of tPA in eligible patients represented either acceptable or ideal patient care. Twenty-seven percent (95% CI: 21.7 to 32.3) indicated use of tPA represented a legal standard of care. Eighty-three percent (95% CI: 78.5 to 87.5) indicated they were “likely” or “very likely” to use tPA given an ideal setting. When asked about using tPA without a consultation, 65% (95% CI: 59.3 to 70.7) indicated they were uncomfortable. Forty-nine percent (95% CI: 43.0 to 55.0) indicated the science regarding use of tPA in stroke is convincing with 30% remaining neutral. Characteristics associated with favorable attitudes included non-emergency medicine board certification; older age, and a smaller hospital practice environment. Conclusions— In this cohort, emergency physician attitudes and beliefs toward intravenous tPA use in stroke are considerably more favorable than previously reported.This publication has 18 references indexed in Scilit:
- Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic AttackCirculation, 2009
- Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic StrokeThe New England Journal of Medicine, 2008
- Survey of Emergency Physicians About Recombinant Tissue Plasminogen Activator for Acute Ischemic StrokeAnnals of Emergency Medicine, 2005
- Acute Stroke Care in the USStroke, 2005
- Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness StudyCMAJ : Canadian Medical Association Journal, 2005
- Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic StrokeStroke, 2004
- Improving Delivery of Acute Stroke TherapyStroke, 2002
- Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community HospitalsStroke, 2001
- Intravenous Tissue Plasminogen Activator for Acute Ischemic StrokeStroke, 2000
- Intravenous Tissue Plasminogen Activator for Acute Ischemic StrokeStroke, 1998