In general, almost half of the discussed barriers were considered external to the provider (e.g., systems issues, patient delays). The barriers internal to the provider were prioritized according to a model of physician behavior change[9]. The hospital barrier assessment process was important because although the top barriers were similar across #for keyword# sites, there was still inter-site variability. This stresses the need for interventions targeted to individual

hospital and provider barriers. The optimal and efficient design of interventions to improve health processes requires a firm understanding of the knowledge and attitudes of the group targeted for the intervention[17]. This is analogous to establishing understanding of the pathophysiology and course of disease prior to the development of a treatment. Past work on barriers to thrombolysis has focused on patient- or hospital-level characteristics and not provider-level barriers[4,6]. Our focus centered on the knowledge and attitudes of the providers at the bedside who were deciding Inhibitors,research,lifescience,medical whether and how to offer thrombolysis to stroke patients. Inhibitors,research,lifescience,medical Providers were cognizant of the importance

of delayed presentation and the difficulties inherent in patient and family symptom recognition and often reported these as important barriers. Further work on the exploration of the interaction between the physician offering therapy and the patient or family member deciding on receiving therapy could provide additional insights into improving treatment rates. The finding that Inhibitors,research,lifescience,medical EPs frequently cited lack of motivation to adhere to, and lack of familiarity with, the content of guidelines for stroke thrombolysis is intuitive. An example of this is the observation that physicians will repeatedly examine patients looking for improvement to justify withholding treatment. Prior and current ongoing methods of examining thrombolytic utilization and Inhibitors,research,lifescience,medical Ponatinib buy eligibility have not captured this. Designing interventions that recognize treatment should occur promptly to combat this hesitancy is important, particularly since providers may delay

even further with the recent publication of data that potentially expands the time window for thrombolysis[18,19]. The lack of familiarity with the guidelines cited as Entinostat a barrier by many respondents often focused on specific procedural issues such as blood pressure control. Difficulty with these and other aspects of the post-treatment guidelines have been observed in prior cohorts of thrombolytic treated stroke patients, although prior investigations focusing on clinician failure to treat patients meeting criteria have been limited[20]. The qualitative methodology utilized in the current investigation was crucial to identifying these important issues and others that have not been captured by prior reviews of thrombolytic cases or EP surveys.