Improving Access to Stroke Care in the Rural Setting: The Journey to Acute Stroke Ready Designation

Slivinski, Andrea; Jones, Robin; Whitehead, Hollis; Hooper, Vallire D.

doi:10.1016/j.jen.2016.10.006

Cited by 13 publications

(8 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Six studies tested interventions that sought to increase the geographic availability of specialty care. Acute stroke access program implementation in one rural western North Carolina emergency department was found to increase care and reduce numerous measurable time-based metrics, such as time to neurological imaging, administration of intravenous thrombolytics, and transfer to a more specialized facility [53]. Implementation of rural telehealth programs also were shown to increase access to specialty care in mental health evaluation in a critical access emergency department [54], medical abortion services in Iowa [55], nephrology care in upstate New York veterans [56], and rheumatology care in New England [57].…”

Section: Resultsmentioning

confidence: 99%

Access to specialty healthcare in urban versus rural US populations: a systematic literature review

Cyr

Etchin

Guthrie

et al. 2019

BMC Health Serv Res

189

127

View full text Add to dashboard Cite

BackgroundAccess to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care.MethodsA systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions.ResultsDespite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence.ConclusionsWhile findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

show abstract

Section: Resultsmentioning

confidence: 99%

Access to specialty healthcare in urban versus rural US populations: a systematic literature review

Cyr

Etchin

Guthrie

et al. 2019

BMC Health Serv Res

189

127

View full text Add to dashboard Cite

show abstract

“…Recent studies, including one performed in Catalonia, have demonstrated that access to EVT from remote areas is limited in high-income countries ( 26 ) and geographic disparities in IVT use are increasing, showing a rural-urban inequality trend ( 27 ). In a rural area of North Carolina, researchers showed that re-organization of the stroke system of care (in that case, to pursuit official certification of the hospital) allowed patients to receive evaluation and treatment in a timely and efficient manner close to home ( 28 ). A recent systematic review aimed to determine the quality of existing stroke-care services in low- and middle-income countries and described great variability, with very low rates of reperfusion therapies (and mainly IVT) provided in large part by the private sector ( 29 ).…”

Section: Ensuring Universal Access To Optimal Treatment the Big Chalmentioning

confidence: 99%

Innovation in Systems of Care in Acute Phase of Ischemic Stroke. The Experience of the Catalan Stroke Programme

Vivanco-Hidalgo

Abilleira

Plana³

et al. 2018

Front. Neurol.

View full text Add to dashboard Cite

Stroke, and mainly ischemic stroke, is the second cause of death and disability. To confront the huge burden of this disease, innovative stroke systems of care are mandatory. This requires the development of national stroke plans to offer the best treatment to all patients eligible for reperfusion therapies. Key elements for success include a high level of organization, close cooperation with emergency medical services for prehospital assessment, an understanding of stroke singularity, the development of preassessment tools, a high level of commitment of all stroke teams at Stroke Centres, the availability of a disease-specific registry, and local government involvement to establish stroke care as a priority. In this mini review, we discuss recent evidence concerning different aspects of stroke systems of care and describe the success of the Catalan Stroke Programme as an example of innovation. In Catalonia, reperfusion treatment rates have increased in recent years and currently are among the highest in Europe (17.3% overall, 14.3% for IVT, and 6% for EVT in 2016).

show abstract

“…We found 49 studies containing information on intra-hospitalar organizational factors associated with delays or access to ART ( Appendix A - Table A3 ). Training emergency room professionals [ 61 , 62 , 63 , 64 , 65 , 66 ], promotion of specific stroke code protocols [ 30 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], direct transfer from ambulance to the imaging room [ 86 , 87 , 88 , 89 , 90 , 91 , 92 ], strategic location of the imaging room (IR) [ 93 ], and routine administration of thrombolysis in the IR, were considered effective strategies to reduce thrombolysis delay [ 68 , 69 , 85 , 86 , 87 , 88 , 89 , 94 , 95 ]. In places where the physician, usually a neurologist, responsible for thrombolysis, is on-call, pre-notification of possible stroke before imaging also reduced delays [ 37 , 68 , …”

Section: Resultsmentioning

confidence: 99%

“…Use of ambulance significantly reduced pre and intra-hospital delays, especially if pre-notification is made to the hospital allowing the hospital teams to check the patient’s previous clinical notes and the put everything involved in the chain of care in “preparedness mode” including the availability of the imaging room [ 12 , 15 , 16 , 17 , 20 , 22 , 23 , 37 , 39 , 40 , 44 , 48 , 51 , 61 , 92 , 96 , 97 , 98 , 110 , 111 , 112 , 113 ]. For time-dependent treatment, such as the ART, implementation of prehospital [ 51 , 61 , 75 , 98 , 107 ] and intrahospital [ 48 , 51 , 59 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 79 , 84 , 86 , 89 , 90 , 91 , 92 , 108 , 109 , 111 , 114 , 115 , 116 , 117 ] protocols are fundamental. Although methodology and pro...…”

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

View full text Add to dashboard Cite

Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

show abstract

Improving Access to Stroke Care in the Rural Setting: The Journey to Acute Stroke Ready Designation

Cited by 13 publications

References 5 publications

Access to specialty healthcare in urban versus rural US populations: a systematic literature review

Access to specialty healthcare in urban versus rural US populations: a systematic literature review

Innovation in Systems of Care in Acute Phase of Ischemic Stroke. The Experience of the Catalan Stroke Programme

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Contact Info

Product

Resources

About