Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
Interv Neuroradiol. 2020 Aug;26(4):420-424. doi: 10.1177/1591019920908131. Epub 2020 Feb 20.
Since 2015, endovascular therapy has been established as a standard of care for acute stroke. This has caused major challenges regarding the organization of systems of care, which have to meet the increasing demand for thrombectomies. This study aims to evaluate how endovascular therapy decisions made by European and North American physicians under their current local resources differ from those made under assumed ideal conditions.
In an international, multidisciplinary survey, physicians involved in acute stroke care were asked to give their treatment decisions to 10 out of 22 randomly assigned stroke case-scenarios. Participants stated (a) their treatment approach under assumed ideal conditions (without any external limitations) and (b) the treatment they would pursue under their current local resources. Resources gaps (ideal minus current endovascular therapy rates) were calculated for different countries/states/provinces and correlated to economic and healthcare key metrics (gross domestic product-per-capita, public or private health insurance coverage, etc.).
A total of 607 physicians, among them 218 from North America and 136 from 25 European countries, responded to the survey. Resources gaps in the majority of North American states/provinces and European countries were small (<5%). The highest gaps were observed among few European countries, namely Poland (30%) and the United Kingdom (33%). The magnitude of the resources gap did not correlate to national economic or healthcare metrics.
In the majority of North American states/provinces and European countries covered in this study, the discrepancy between endovascular therapy decisions under current local resources and assumed ideal conditions seems to be small, even in countries with a limited economic status and healthcare infrastructure.
自 2015 年以来，血管内治疗已被确立为急性脑卒中的标准治疗方法。这对护理系统的组织提出了重大挑战，因为必须满足日益增长的取栓需求。本研究旨在评估欧洲和北美的医生在其当前当地资源下做出的血管内治疗决策与在假设的理想条件下做出的决策有何不同。
在一项国际多学科调查中，参与急性脑卒中护理的医生被要求对 22 个随机分配的脑卒中病例情景中的 10 个给出治疗决策。参与者陈述了（a）在假设的理想条件下（没有任何外部限制）的治疗方法和（b）在当前当地资源下他们会选择的治疗方法。为不同的国家/州/省计算了资源差距（理想与当前血管内治疗率之间的差异），并与经济和医疗保健关键指标（人均国内生产总值、公共或私人医疗保险覆盖率等）相关联。
共有 607 名医生，其中 218 名来自北美，136 名来自 25 个欧洲国家，对调查做出了回应。在大多数北美州/省和欧洲国家，资源差距较小（<5%）。在少数几个欧洲国家，如波兰（30%）和英国（33%），差距最大。资源差距的大小与国家的经济或医疗保健指标无关。
在本研究涵盖的大多数北美州/省和欧洲国家中，当前当地资源下的血管内治疗决策与假设的理想条件下的决策之间的差异似乎很小，即使在经济状况和医疗保健基础设施有限的国家也是如此。
