- Title
- Thrombolysing patients experiencing ischemic stroke: can an implementation intervention improve care pathways, clinical practice, and perceptions?
- Creator
- Hasnain, Md Golam
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background Intravenous thrombolysis is a mainstream medical treatment used in cases of acute ischaemic stroke. Despite being approved by the United States Food and Drug Administration as a first-line treatment in 1996, its usage is still low – less than 15% of all stroke cases, in most parts of the world. The Thrombolysis ImPlementation in Stroke (TIPS) study used a cluster-randomized, multi-component in-hospital trial across 20 hospitals in Australia to assess the effectiveness of a strategy to increase hospital usage of intravenous thrombolysis in cases of acute ischaemic stroke. The TIPS study found an intermittent increase in intravenous thrombolysis rates in the intervention hospitals, which was not sustained beyond the 16-month active intervention period. Therefore, we sought to investigate the insights yielded by the TIPS data to identify practical and efficient strategies to increase the rates of intravenous thrombolysis in acute ischaemic stroke. Aims, Method, and Results Two post hoc analyses were conducted using the TIPS data to explore clinical practice at participating hospitals during the TIPS trial. To this end, we tested the effect of the intervention on a) door-to-needle time for intravenous thrombolysis and b) patient clinical outcomes. The analyses indicated that the TIPS intervention resulted in non-significant changes within the experimental groups for both outcomes. Secondly, data from two cross-sectional TIPS surveys were used to evaluate the effects of the intervention on physician and nurse perceptions of intravenous thrombolysis. It was found that the TIPS intervention had changed some aspects of nurse perceptions. Still, there was no evidence of changes in physician perceptions, albeit with limited statistical power to detect changes in the physician group. A systematic review and meta-analysis examined the published interventions, which sought to improve usage rates of intravenous thrombolysis. Interventions were categorized using the Behaviour Change Wheel intervention functions. The results identified overall significant effects for all intervention approaches, regardless of intervention type. Discussion and Conclusion The combined data presented in the thesis are discussed in terms of three main findings: non-significant effect of TIPS intervention on door-to-needle time for intravenous thrombolysis and 18 clinical outcome, a significant effect of TIPS intervention in changing some aspects of nurses-only perceptions related to intravenous thrombolysis, and the overall significant effect of all published intervention approaches, measured through systematic review and meta-analysis. The limitations and implications of the findings are discussed in relation to education and training modules and methods, careful development of situation-specific intervention strategies, and exploration of novel strategies such as the use of incentives for achieving benchmark performance in intravenous thrombolysis.
- Subject
- acute Ischemic Stroke; thrombolysis; implementation Intervention; behaviour Change Wheel
- Identifier
- http://hdl.handle.net/1959.13/1422603
- Identifier
- uon:37855
- Rights
- Copyright 2020 Md Golam Hasnain
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 465 KB | Adobe Acrobat PDF | View Details Download |