Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta‐analysis

Lazarus, Gilbert; Permana, Affan Priyambodo; Nugroho, Setyo Widi; Audrey, Jessica; Wijaya, Davin Nathan; Widyahening, Indah Suci

doi:10.1002/brb3.1787

Cited by 28 publications

(20 citation statements)

References 45 publications

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“…6,11,12 There are mixed reports on the quality of care provided by telemedicine; some sources report improved or maintained standards of care, whereas others found a reduction in quality of care compared to FTF scenarios. 9,[13][14][15][16][17][18][19] In spite of the extensive research into the effectiveness, cost and perceptions of telemedicine, there have been few contributions assessing the environmental impact; despite many previous studies stating a reduction in travel time and the increasing awareness of environmental concerns within society. 7,[20][21][22][23] In a world where climate change has been named as one of the biggest threats to human health, the healthcare sector continues to significantly contribute to greenhouse gas (GHG) emissions.…”

Section: Introductionmentioning

confidence: 99%

Does telemedicine reduce the carbon footprint of healthcare? A systematic review

Purohit

Smith

Hibble³

2021

Future Healthcare Journal

129

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In the rapidly progressing field of telemedicine, there is a multitude of evidence assessing the effectiveness and financial costs of telemedicine projects; however, there is very little assessing the environmental impact despite the increasing threat of the climate emergency. This report provides a systematic review of the evidence on the carbon footprint of telemedicine. The identified papers unanimously report that telemedicine does reduce the carbon footprint of healthcare, primarily by reduction in transport-associated emissions. The carbon footprint savings range between 0.70-372 kg CO 2 e per consultation. However, these values are highly context specific. The carbon emissions produced from the use of the telemedicine systems themselves were found to be very low in comparison to emissions saved from travel reductions. This could have wide implications in reducing the carbon footprint of healthcare services globally. In order for telemedicine services to be successfully implemented, further research is necessary to determine context-specific considerations and potential rebound effects.

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Section: Introductionmentioning

confidence: 99%

Does telemedicine reduce the carbon footprint of healthcare? A systematic review

Purohit

Smith

Hibble³

2021

Future Healthcare Journal

129

View full text Add to dashboard Cite

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“…The current pandemic situation of COVID-19 made evident the benefits of telehealth, as well as the need to improve access and proficiency in the use of technologies by professionals 23 . It can also contribute to a transformation of health care, improving several procedures, allowing close follow-up, and contributing to better clinical outcomes 1,2,24 .…”

Section: Discussionmentioning

confidence: 99%

Brazilian phonoaudiology telepractice before and during the COVID-19 pandemic

et al. 2022

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Purpose: to analyze the use of digital resources by Brazilian phonoaudiologists before and during the period of the COVID-19 pandemic. Methods: cross-sectional study carried out with a representative sample of Brazilian phonoaudiologists, with at least one year of practical experience. An online questionnaire consisting of 28 questions divided into eight sections was prepared. Data were analyzed and are reported as absolute and relative frequency regarding the variables: respondent's age, highest degree and years of experience; weekly working hours; region of the country; type of service and area of expertise; use of digital means before and during the pandemic and willingness to use the same kind of resource after the pandemic. Results: telehealth technologies were used by 90% of phonoaudiologists in Brazil since before the COVID-19 pandemic. A change in the profile of technologies used was observed: after the pandemic, videoconferences gained more use in contact with patients compared to the pre-pandemic period even though contact via mobile phone and instant messaging applications are the most used, both before and during the pandemic. Conclusion: the study's findings demonstrate that 90% of phonoaudiologists who answered the questionnaire in Brazil used and still make use of telehealth technologies to contact patients.

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“…They also may be cost effective, at least in densely populated urban settings where multiple tertiary stroke care centers are available (14)(15)(16). Their role in rural and resource-limited settings, however, has not been systematically evaluated (17). Furthermore, MSUs are still dependent on a neurologist present and staffing these stroke calls in the ambulance.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Furthermore, MSUs are still dependent on a neurologist present and staffing these stroke calls in the ambulance. Given these inherent challenges, they are unlikely to be widely adopted in rural settings where effective telestroke and pre-hospital triage systems have been demonstrated to be more impactful (17).…”

Section: Discussion/conclusionmentioning

confidence: 99%

A Case for the Non-Neurologist Telestroke Provider

2021

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Introduction: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. We hypothesize that rates of tPA recommendation, sensitivity of final diagnosis, and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations.Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center over 1 year. Statistical analysis: Chi squared test.Results: Three hundred and three consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non-stroke-trained neurologists, and 59% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine-trained, stroke neurology-trained and other neurology- trained provider groups, respectively (p = 0.427). Sensitivity of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group.Discussion/Conclusion: Our results did not illustrate any statistically significant difference between care provided by an emergency medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore, may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

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Telestroke strategies to enhance acute stroke management in rural settings: A systematic review and meta‐analysis

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 28 publications

References 45 publications

Does telemedicine reduce the carbon footprint of healthcare? A systematic review

Does telemedicine reduce the carbon footprint of healthcare? A systematic review

Brazilian phonoaudiology telepractice before and during the COVID-19 pandemic

A Case for the Non-Neurologist Telestroke Provider

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