Publication: Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers’ perspective
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Date
2024
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
Background: Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that infuenced the provision of IVT and the variation in its rates in Malaysia.
Methods: A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with difering rates of IVT using a multiple method design. Twenty-fve in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using refective thematic method, before triangulated with quantitative fndings.
Results: Of fve factors identifed, three factors that distinctively infuenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workfow simplifcation and familiarity with IVT. Two other factors that were consistently identifed as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed
the opportunity to receive IVT due to delayed presentation.
Conclusions: In addition to the global efort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workfow optimisation.
Description
Keywords
Acute stroke care, Intravenous thrombolysis, Developing countries, Translational research, Determinants, Factors