Liu Qiliang, Ranta Annemarei Anna, Abernethy Ginny, Barber P Alan
Trainee Intern, Departments of Neurology, Auckland City Hospital and University of Auckland.
Neurologist and National Clinical Leader Stroke, Department of Neurology, Wellington Regional Hospital and University of Otago.
N Z Med J. 2017 Apr 7;130(1453):57-62.
To obtain an overall picture of the organisation of stroke thrombolysis provision in New Zealand hospitals and compare changes between 2011 and 2016.
Surveys were distributed to all New Zealand district health boards (DHBs) in 2011 and 2016, and included questions about the infrastructure, staffing, training, guidelines and audit provided for stroke thrombolysis.
Responses were received from all DHBs, with 86% offering stroke thrombolysis in 2011 and 100% in 2016. In 2016, thrombolysis rosters of large DHBs (those with a population >250,000 people) had a mean (range) of 14 (5-34) clinicians, approximately double that of medium-sized DHBs (population 125-250,000) who had eight (3-15) and small DHBs (population <125,000) with seven, (2-13) clinicians. While a similar distribution of senior medical officer clinical specialty was seen across medium and small DHBs in both years, large DHBs in 2016 had a higher number of neurologists (5, 1-12) and an increasing number of general physicians (8, 0-30) rostered to provide thrombolysis compared to 2011. Thrombolysis services at medium and small DHBs are chiefly managed by general physicians and geriatricians, while telestroke support was only available in three medium-sized DHBs. In 2016, all hospitals had developed thrombolysis guidelines and audited thrombolysed patients in the National Stroke Thrombolysis Register, which is an improvement compared with 2011 when only seven (39%) DHBs reported regular audit. Challenges in staffing and training remain greatest in smaller and geographically isolated DHBs.
While there have been improvements in the provision of stroke thrombolysis throughout New Zealand, regional variations in service quality remains. The needs for better solutions to geographical barriers and formal training must be addressed as priorities.
全面了解新西兰医院中风溶栓治疗的组织情况，并比较2011年至2016年期间的变化。
分别在2011年和2016年向新西兰所有地区卫生委员会（DHBs）发放调查问卷，内容包括中风溶栓治疗的基础设施、人员配备、培训、指南及审计等方面的问题。
收到了所有DHBs的回复，2011年提供中风溶栓治疗的比例为86%，2016年为100%。2016年，大型DHBs（人口超过25万的地区）的溶栓值班表上平均有14名（范围为5 - 34名）临床医生，约为中型DHBs（人口12.5万 - 25万）的两倍，中型DHBs有8名（3 - 15名）临床医生，小型DHBs（人口少于12.5万）有7名（2 - 13名）临床医生。在这两年中，中型和小型DHBs高级医务人员的临床专业分布相似，但与2011年相比，2016年大型DHBs有更多的神经科医生（5名，范围为1 - 12名）和越来越多的全科医生（8名，范围为0 - 30名）参与溶栓值班。中型和小型DHBs的溶栓服务主要由全科医生和老年病科医生管理，而远程中风支持仅在三个中型DHBs中可用。2016年，所有医院都制定了溶栓指南，并在国家中风溶栓登记册中对溶栓患者进行了审计，与2011年相比有所改善，当时只有7个（39%）DHBs报告进行了定期审计。人员配备和培训方面的挑战在较小且地理位置偏远的DHBs中仍然最为突出。
虽然新西兰中风溶栓治疗的提供情况有所改善，但服务质量仍存在地区差异。必须优先解决地理障碍和正规培训的更好解决方案的需求。
