Stroke networks and telemedicine: An Italian national survey

Abstract

Stroke is the leading cause of disability and death. Nowadays, clinical benefits of stroke units and thrombolysis in ischemic stroke are evidence-based. Also the benefit of endovascular treatment for acute ischemic stroke has been established. Telemedicine has been used to improve access to care by allowing a neurologist at a remote location to interact with the patient and their family members. Prior studies have shown that the use of telemedicine for acute ischemic stroke is not only safe and effective, but it also increases the utilization of tPA, improving patient outcomes. This study aimed to investigate the diffusion of telemedicine in Italian stroke networks with an online questionnaire to assess: type of stroke care setting, Volume of thrombolysis- thrombectomy/year, access to stroke care between different hospitals, the presence of imaging sharing protocols within the network or patients dispatchment screening; type of network solutions. We have interviewed 24 Italian neurologists, working in large urban areas, from north southward, including Italian islands. In particular, these neurologists represented 14 different regions and 20 countries. A majority of neurologists replying to the survey (47.83%) worked in large general hospitals or smaller general hospitals (26%) and a smaller number of physicians (17.3%) were committed in University Hospital or (8.7%) independent foundation hospitals. The 60.87% of stroke networks involved in the survey had a low thrombolysis/year volume while the 30.43% had a thrombolysis/year volume above 100. According to the survey a local stroke network was established in 87.50% of cases. In the 45.83% of cases, the hospitals care is not homogeneous within the network. A network for the consultation of neuroimaging between hospitals is available in 33.33% of cases. Whitin those describing an active network for Teleconsult the 57.14% used personal devices, while only the 25 % use professional teleconference system, and in 25% of cases used medical devices. Our findings demonstrated a relevant diffusion of Teleconsult in Italian stroke networks. The systems adopted are mostly individual solutions not integrated in protocolled pathways. These findings may encourage a systematization of Telemedicine medical curricula to increase larger access to neurological consults.

Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective

“…Telemedicine solutions were found to be feasible and cost-effective in many neurological diseases, as well as Multiple Sclerosis (MS) [ 4 , 5 , 6 , 7 ]. Specific, quickly deployable, and mobile telemedicine solutions may increase the access to care for patients with mobility limitations or geographic barriers [ 8 ].…”

The experience of patients with diabetes with the use of telemedicine and teleassistance services during the COVID-19 pandemic in Italy: Factors associated with perceived quality and willingness to continue

“…Sixty-four percent of patients expressed their willingness to continue using TMTA services even beyond the COVID-19 pandemic. Considering the novelty of TMTA services, whose adoption before 2020 in Italy was sporadic and often limited to pilot initiatives and specific subgroups of patients [24], the fact that almost two thirds of people with diabetes would continue with these innovative services can be deemed as an important signal that it is possible to innovate healthcare services even in systems that have proven to be more resistant to changes over the years [17]. To ensure a high perceived quality of the services and a willingness to continue is therefore mandatory to investigate their socio-demographic, contextual and TMTA-related determinants.…”

“…Ethical approval to undertake this research was granted from the Comitato Etico Romagna (CEROM) with decree n. 2542 of July 30, 2020 [24].…”

Mobile Screening Units for the Early Detection of Breast Cancer and Cardiovascular Disease: A Pilot Telemedicine Study in Southern Italy

“…Development of new technology innovations and their different telemedicine applications in integrated care programs, such as teleassessments, have positive effects on the quality of care in chronic patients. 14,15,17,18 Although telemedicine has been shown to be useful for screening, diagnosis, and management in different studies, [19][20][21] there are still serious difficulties including deficiency of provider availability, community access to screening, and community demand for screening. 22,23 Challenges related to health care providers can involve scarcity in screening delivery or policies requiring a consultation from a family physician to access screening.…”