Impact of an outpatient telestroke clinic on management of rural stroke patients

• Published in: The Australian journal of rural health Vol. 30; no. 3; pp. 337 - 342
• Main Authors: Garcia‐Esperon, Carlos, Chew, Beng Lim Alvin, Minett, Fiona, Cheah, Joseph, Rutherford, Jennifer, Wilsmore, Bradley, Parsons, Mark W., Levi, Christopher R., Spratt, Neil J.
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-06-2022
• Subjects: Attendance; Care coordinators; Clinical research; Clinical trials; Diagnosis; Drugs; Feasibility; Intervention; Ischemia; Medical diagnosis; Patients; Rehabilitation; remote regions; Rural health care; secondary prevention; Stroke; telehealth; Telemedicine; transient ischaemic attack; Transient ischemic attack; Video conferencing; Videoconferencing; transient ischaemic attack; secondary prevention; stroke; telehealth; remote regions
• ISSN: 1038-5282; 1440-1584
• DOI: 10.1111/ajr.12849

Objective
Report on feasibility, use and effects on investigations and treatment of a neurologist‐supported stroke clinic in rural Australia.
Design
Data were collected prospectively for consecutive patients referred to atelehealth stroke clinic from November 2018 to August 2021.
Settings, participants and interventions
Patients attended the local hospital, with a rural stroke care coordinator, and were assessed by stroke neurologist over videoconference.
Main outcome measures
The following feasibility outcomes on the first appointments were analysed: (1) utility (a) change in medication, (b) request of additional investigations, (c) enrolment/offering clinical trials or d) other; (2) acceptability (attendance rate); and (3) process of care (waiting time to first appointment, distance travelled).
Results
During the study period, 173 appointments were made; 125 (73.5%) were first appointments. The median age was 70 [63–79] years, and 69 patients were male. A diagnosis of stroke or transient ischemic attack was made by the neurologist in 106 patients. A change in diagnosis was made in 23 (18.4%) patients. Of the first appointments, 102 (81.6%) resulted in at least one intervention: medication was changed in 67 (53.6%) patients, additional investigations requested in 72 (57.6%), 15 patients (12%) were referred to a clinical trial, and other interventions were made in 23 patients. The overall attendance rate of booked appointments was high. The median waiting time and distance travelled (round‐trip) for a first appointment were 38 [24–53] days and 60.8 [25.6–76.6] km respectively.
Conclusion
The telestroke clinic was very well attended, and it led to high volume of interventions in rural stroke patients.