Telestroke: Barriers to the Transition

Gamboni, Alessio; Calabrò, Giuseppe; Zampolini, Mauro; Zedde, Marialuisa; Caso, Valeria; Corea, Francesco

doi:10.3389/fneur.2021.689191

Cited by 8 publications

(14 citation statements)

References 25 publications

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“… 17 Emergency Medical Services Specialized stroke care within ambulances remains not establish, and the limited number of stroke centers. 18 Financial Issues The paucity of mechanical thrombectomy coverage by national insurance has significant repercussions 19 Lack of Public Awareness The community does not familiar with F.A.S.T 20 Abbreviations : EVT, Endovascular Thrombectomy; F.A.S.T, Face.Arm.Speech.Time signs of Stroke. …”

Section: Resultsmentioning

confidence: 99%

“…In addition, telemedicine and telestroke programs provide innovative means of overcoming geographical limitations. 20 , 38 These programs facilitate real-time assessment and decision-making regarding EVT by facilitating remote consultation between stroke experts and healthcare providers in underserved areas. 20 Telemedicine can resolve the expertise divide, increasing the accessibility of stroke care in regions where specialized stroke centers are scarce or nonexistent.…”

Section: Discussionmentioning

confidence: 99%

“… 20 Telemedicine can resolve the expertise divide, increasing the accessibility of stroke care in regions where specialized stroke centers are scarce or nonexistent. 20 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

Rilianto,

Kurniawan,

Rajab

et al. 2024

NDT

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High rates of morbidity and mortality indicate that stroke is a major health concern. Unfortunately, the management of ischemic stroke is hindered by several obstacles, particularly in developing countries such as Indonesia, where the burden of morbidity and mortality remains high. In this literature review, we intend to conduct a thorough investigation and analysis of the obstacles to stroke thrombectomy in developing countries, with a focus on Indonesia. Even though numerous studies and recent advances in thrombectomy techniques have been developed, many centers around the world continue to struggle to implement them. The majority of these institutions are located in developing nations like Indonesia. It faces numerous obstacles, including a lack of public awareness, infrastructure, human resources, and financial difficulties. The absence of early education and large-scale campaigns contributes to the dearth of public awareness. Inadequate imaging facilities, prehospital and referral systems, as well as disparities in healthcare expenditure and accessibility, contribute to the absence of infrastructure. Inadequate numbers of neurointerventionists, neurologists, and neurosurgeons, as well as a disparate distribution of these professionals, contribute to human resource issues. Inadequate national insurance coverage, high import tariffs on medical devices, and the high cost of healthcare have a negative impact on the financial situation. We provide related strategies regarding the current situation in Indonesia based on the recent evidence and comparison with developed countries. Academic institutions, medical associations, and government agencies must collaborate to overcome these challenges.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

Rilianto,

Kurniawan,

Rajab

et al. 2024

NDT

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“…Barriers that may present early on when establishing a new network include sustainability despite low patient volume and the ability to scale-up the network when faced with limited funding. 9 , 10 Maintenance of an established telestroke network also presents challenges related to funding, staffing, technological difficulties, and the ability to standardize the triage process among all spoke sites. 9 , 10 Despite these barriers, the benefits from a patient perspective are well-established.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Telestroke Usage in Rural Critical Access Emergency Departments

Arumuganathan

Adcock

Espinosa

et al. 2023

Telemedicine and e-Health

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Introduction: Telestroke is an effective strategy to increase appropriate stroke treatments among patients in resource-limited environments. Despite the well-documented benefits of telestroke, there is limited literature regarding its utilization. The purposes of this study are: (1) determine the percentage of potential stroke patients who generate a telestroke consult in rural critical access hospitals (CAHs) and (2) validate an electronic medical record (EMR)-derived report as a stroke screen. Methods: This retrospective chart review analyzed patients presenting between September 1, 2020 and February 1, 2021 to three CAHs. Visits with triage complaints suggesting acute ischemic stroke (AIS)/transient ischemic attack (TIA) were pooled for analysis using an EMR-derived report. Patients with confirmed AIS/TIA at discharge over this period were used to validate the EMR tool. Results: The EMR report pooled 252 possible AIS/TIA visits out of 12,685 emergency department visits for analysis. It had a specificity of 98.78% and sensitivity of 58.06%. Of the 252 visits, 12.7% met telestroke criteria and 38.89% received telestroke evaluation. Among these, a definite diagnosis of AIS/TIA was made in 92.86%. Of the remaining population who met criteria but didn't undergo consultation, 61.11% were diagnosed with AIS/TIA at discharge. Conclusion: This study provides novel characterization of stroke presentations and telestroke in rural CAHs. The EMR-derived report is a reasonable tool to concentrate potential AIS/TIA cases for review and resource allocation but is not sensitive enough to detect stroke as a stand-alone tool. The majority (56%) of eligible patients did not undergo telestroke consultation. Future studies are critical to further understand reasons contributing to this.

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“…The availability of digital health-integrated standard operating procedures (SOPs) for main clinical lines would support the decision-making process and minimize errors. Medical educational models should be reorganized on many levels, and stakeholders should reserve an open-minded approach to this process, in order to avoid the risk of being overwhelmed or miss useful opportunities [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Extending Thrombolysis in Acute Ischemic Stroke to Primary Care: Early Experiences with a Network-Based Teleneurology Approach

Corea

Acciarresi

Bernetti

et al. 2022

Neurology International

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Background and Purpose—Systemic thrombolysis represents the main proven therapy for acute ischemic stroke, but safe treatment is reported only in well-established stroke units. To extend the use of tissue plasminogen activator (tPA) treatment in primary care hospitals on isolated areas through telemedic was the purpose of specific initiatives in southern Umbria, Italy. Methods—The stroke center of Foligno established a telestroke network to provide consultations for three local hospitals in southern Umbria. The telemedic system consists of a digital network that includes a two-way video conference system and imaging sharing. The main network hospital established specialized stroke wards/teams in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 h per day. Quality data are available to support the safe implementation of the stroke procedures. Those available from governmental authorities and local datasets are volume of hospitalization, in-hospital mortality, 30-days mortality, and discharge setting. Objective of the study was to assess the annual hospitalization volume in both the hub and spoke hospitals for ischemic stroke and appraise the performance of the network after the introduction of the telestroke system. Results—A total of 225 systemic thrombolyses were performed in time period indicated above all hospitals. In the main spoke hospital, 41 procedures were performed after teleconsultations were made available. The thrombolysis rate in the hub hospital ranged between 10% in 2016 and 20% in 2019, while in the spoke hospital was below 5% in 2016 and raised to 15% in 2019. The statistically significant difference, in the number of procedures, between hub and spoke in the beginning of the observation time disappeared after introduction of the telestroke network. No increase of the mortality was found. Conclusions—The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation shows similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to primary hospitals.

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Telestroke: Barriers to the Transition

Cited by 8 publications

References 25 publications

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

Analysis of Telestroke Usage in Rural Critical Access Emergency Departments

Extending Thrombolysis in Acute Ischemic Stroke to Primary Care: Early Experiences with a Network-Based Teleneurology Approach

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