rt-PA施打率以及醫院人力配置的關聯

Abstract

靜脈注射rt-PA是唯一經美國食管局批准的急性腦梗塞治療藥物。台灣的rt-PA施打率約為0.60％, 相比之下較低於其他亞洲已開發國家。我們的研究目標，是藉由評估醫院特點、人力資源和rt-PA施打率之間的關係，來釐清rt-PA施打率較低的原因。 由於先前的研究已知台灣各地區的施打率不盡相同，故在此研究中也有將地區設作控制變數。在控制地區這個因素之後，我們發現急診醫師的數量、急診醫生的年齡、中風的嚴重程度和中風的季節與rt-PA的施打率有相關。基於以上觀察，我們認為急診醫師可能是急性腦中風治療計劃的關鍵決策者。希望後續有進一步的研究及相關的政策調整，以解決急診醫師人力資源短缺及急性腦中風低治療率的問題。

Intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) is the only Food and Drug Administration-approved therapy for acute ischemic stroke (AIS). The rt-PA utilization rate is relatively low in Taiwan. Therefore, we aim to evaluate the barriers of AIS treatment by evaluating the relationships among hospital’s characteristics, human resources, and the rt-PA administration rate. Previous study shows that the rt-PA administration rates are different in different region in Taiwan. After controlling the regional factors, we find that the number of the emergency physicians, the age of emergency physicians, the severity of stroke, and the season are related with the rt-PA administration. Hence, we suggest that the emergency physician might be the key decision maker to initiate the code stroke and efficient thrombolysis therapy. Further nationwide survey to clarify the phenomenon, and the policy to solve the human resources shortage should be applied in the future. By improving the AIS treatment, we hope to decrease the economic burden of stroke in healthcare system.