Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism

Abstract

Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.

Challenges of delivering evidence‐based stroke services for rural areas in Australia

“…Timely care is essential for stroke patients and the lack of specific stroke units can be a barrier here, however, in this case, other options such as transfers to another medical facility and telemedicine for assessment and thrombolysis may be of some use as there is often limited access to physicians and diagnostic services . Interventions such a telemedicine, or e‐health and other technology‐based interventions have been utilised to assist healthcare professionals to provide specialist stroke care in rural or remote areas in many regions worldwide . This form of care, although not always relevant to every stroke case, may deliver on several evidence‐based practices that are currently lacking in Australian rural areas, such as staff resources, medical training and specialist consultation as well as areas of preventative health care and health promotion activities related to stroke.…”

“…10 Interventions such a telemedicine, or e-health and other technology-based interventions have been utilised to assist healthcare professionals to provide specialist stroke care in rural or remote areas in many regions worldwide. 17 This form of care, although not always relevant to every stroke case, may deliver on several evidence-based practices that are currently lacking in Australian rural areas, such as staff resources, medical training and specialist consultation as well as areas of preventative health care and health promotion activities related to stroke.…”

Differences in factors influencing the use of eRehabilitation after stroke; a cross-sectional comparison between Brazilian and Dutch healthcare professionals

“…The statements with the least influence on the use of eRehabilitation were comparable for BHP and DHP, and were related to patient characteristics and resources. This means that BHP and DHP indicate that the use of eRehabilitation is influenced by different factors and tailored implementation strategies for both countries need to be developed separately (16).…”

“…Studies performed in western countries concluded that eRehabilitation programs are generally considered feasible (5), however, in low-and middle income countries, future trails on the feasibility are needed (15). Furthermore, it has been shown that eRehabilitation interventions need to address culture-specific issues in order to be effective (23), however, eRehabilitation interventions for patients are rarely culturally-adapted (16).…”

“…To improve the uptake of eRehabilitation after stroke, the identification of barriers and facilitators influencing this use is needed (16). Most of the abovementioned research about barriers/facilitators in the use of eRehabilitation is performed in western countries (America, Canada, Australia, Europe), and as far as we know, no research is performed on the differences between western countries and other regions.…”