Quantitative Analysis of Barriers and Facilitators to Adopting Tenecteplase

INTRODUCTION: Tenecteplase (TNK) is an emerging treatment for acute ischemic stroke (AIS) being adopted in place of alteplase (ALT). Compared to ALT, TNK has a longer half-life, shorter administration time, lower cost, and similarly high efficacy in treating large vessel occlusion. Nevertheless, there are barriers to TNK adoption as a treatment for AIS. OBJECTIVES: The objective of this study is to identify barriers and facilitators to TNK implementation at hospitals within the state of Texas and present them in a quantifiable presentation. MATERIALS & METHODS: This study examines questionnaire responses from 40 hospitals to examine barriers and facilitators to transition from ALT to TNK. Surveys were done via teleconference with stroke coordinators and physicians associated with the Lone Star Stroke Research Consortium and other regional Texas hospitals. The consortium comprises participants from 6 hub hospitals and 28 spoke hospitals including community-based facilities to Comprehensive Stroke Centers (CSC). Interviews lasting 10-20 minutes were conducted where nominal variables like hospital bed information, stroke information, thrombolytic use, and ordinal variables were recorded utilizing a Likert questionnaire. The participants were blinded to the survey questions to reduce bias. DISCUSSION/RESULTS: The 40 Texas hospitals had a mean of 40 ED beds, 49 stroke beds, 685 annual stroke admissions out of which 14.5%, were hemorrhagic, 18% Transient Ischemic Attack (TIA) and 66.5% AIS respectively. There were 20 (50%) CSC hospitals, 2 (5%) thrombectomy capable, 16 (40%) primary stroke centers, and 2 (5%) were acute stroke ready hospitals. Compared to hospitals that successfully adopted TNK, non-adopters had significantly different views on the barrier of adequate evidence (P <.05), TNK delivery times (P<.05), and legal issues regarding giving TNK (P<.05). However, hospitals were similar in respect to the barriers of having a TNK policy (P=.094), buy-in from administration (P=.276), the cost of TNK (P=.089), and the willingness of pharmacy to adopt TNK (P=.242). SUMMARY/CONCLUSION: There is a generalizable pattern of barriers and facilitators from the perspective of stroke coordinators and physicians. The results will be used to develop a TNK adoption Toolkit.