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Original Contribution
April 2007

Slow Progressive Acceptance of Intravenous Thrombolysis for Patients With Stroke by Rural Primary Care Physicians

Author Affiliations

Author Affiliations: Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City.

Arch Neurol. 2007;64(4):518-521. doi:10.1001/archneur.64.4.518

Background  In the rural United States, patients with stroke are usually first evaluated locally by a nonneurologist physician (NNP) before treatment is determined.

Objective  To determine the evolution of NNPs' familiarity and attitudes about using recombinant tissue plasminogen activator (rtPA) since this therapy has been approved.

Design  Cross-sectional design using 2 similar surveys mailed in 1997 and 2003 to all primary care, family, internal, and emergency medicine physicians in the state of Iowa (1582 and 1679 physicians, respectively).

Participants  All NNPs (primary care, internal, and emergency medicine) practicing in the state of Iowa.

Main Outcome Measures  Comparison of 1997 and 2003 aggregate responses to questions about familiarity and willingness to use rtPA to treat patients who have had an acute ischemic stroke.

Results  The willingness of NNPs to use rtPA to treat acute ischemic stroke increased from 18% to 32% between 1997 and 2003. The number of NNPs who were very familiar with the National Institutes of Health Stroke Scale increased from 1% to 13%. Compared with physicians in 1997, more physicians in 2003 knew that prolonged international normalized ratios (42% vs 61%) or excessively high blood pressures (61% vs 78%) were contraindications for the use of rtPA. Still, half of the respondents perceived that they were inadequately exposed to educational material about rtPA during these years. Most expressed preference for personal methods of delivery for future educational efforts.

Conclusions  The familiarity and comfort among NNPs with the administration of rtPA is still relatively low in rural settings. The improvement observed between the years 1997 and 2003 is encouraging. The responses suggest that NNPs' acceptance of rtPA can be further improved with educational campaigns involving personal methods of delivery.