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Kocanda L, Fisher K, Brown LJ, May J, Rollo ME, Collins CE, Boyle A, Schumacher TL. Informing telehealth service delivery for cardiovascular disease management: exploring the perceptions of rural health professionals. AUST HEALTH REV 2021; 45:241-246. [PMID: 33715764 DOI: 10.1071/ah19231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.
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Affiliation(s)
- Lucy Kocanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Corresponding author.
| | - Karin Fisher
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ;
| | - Leanne J Brown
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ;
| | - Jennifer May
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ;
| | - Megan E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. ; ; and Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia. ; ; ; and Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia. ;
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Dwyer M, Peterson G, Gall S, Kinsman L, Francis K, Ford K, Castley H, Kitsos A, Hilliard T, English J. Regional differences in access to acute ischaemic stroke care and patient outcomes. Intern Med J 2021; 50:965-971. [PMID: 31566867 DOI: 10.1111/imj.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas being relatively disadvantaged. It remains unclear, however, whether such disparities have led to corresponding differences in patient outcomes. AIMS To describe the regional differences in acute ischaemic stroke care and outcomes within the Australian state of Tasmania. METHODS A retrospective case note audit was used to assess the care and outcomes of 395 acute ischaemic stroke patients admitted to Tasmania's four major public hospitals. Sixteen care processes were recorded, which covered time-critical treatment, allied health interventions and secondary prevention. Outcome measures were assessed using 30-day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression. RESULTS No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients' access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-day mortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46-2.18) or discharge destination (OR = 1.24, 95% CI 0.81-1.91). CONCLUSIONS With the exception of acute stroke unit care and thrombolysis, acute ischaemic stroke care within Tasmania's urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes. Future studies are encouraged to employ larger data sets, which capture a broader range of urban and rural sites and record patient outcomes at extended interval.
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Affiliation(s)
- Mitchell Dwyer
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Greg Peterson
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Seana Gall
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Francis
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen Ford
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Helen Castley
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Alex Kitsos
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Tamsin Hilliard
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Jennifer English
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
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Patel H, Damush TM, Miech EJ, Rattray NA, Martin HA, Savoy A, Plue L, Anderson J, Martini S, Graham GD, Williams LS. Building cohesion in distributed telemedicine teams: findings from the Department of Veterans Affairs National Telestroke Program. BMC Health Serv Res 2021; 21:124. [PMID: 33549097 PMCID: PMC7865113 DOI: 10.1186/s12913-021-06123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid remote stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identified cohesion-related factors in program development and support. METHODS We studied the virtual hub of stroke specialists employed by the NTSP. Semi-structured, confidential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and team cohesion, and we identified factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. RESULTS Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with co-located colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP. CONCLUSION A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promote cohesion in distributed telemedicine teams.
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Affiliation(s)
- Himalaya Patel
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.
| | - Teresa M Damush
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- VA HSR&D Precision Monitoring for Quality Improvement (PRIS-M) QUERI Center, Indianapolis, Indiana, USA
| | - Edward J Miech
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- VA HSR&D Precision Monitoring for Quality Improvement (PRIS-M) QUERI Center, Indianapolis, Indiana, USA
| | - Nicholas A Rattray
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- VA HSR&D Precision Monitoring for Quality Improvement (PRIS-M) QUERI Center, Indianapolis, Indiana, USA
| | - Holly A Martin
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- VA HSR&D Precision Monitoring for Quality Improvement (PRIS-M) QUERI Center, Indianapolis, Indiana, USA
| | - April Savoy
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Laurie Plue
- VA Office of Specialty Care Services, Neurology, San Francisco, California, USA
| | - Jane Anderson
- VA Office of Specialty Care Services, Neurology, San Francisco, California, USA
| | - Sharyl Martini
- VA Office of Specialty Care Services, Neurology, San Francisco, California, USA
| | - Glenn D Graham
- VA Office of Specialty Care Services, Neurology, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Linda S Williams
- Center for Health Information and Communication (CIN 13-416), Health Services Research and Development (HSR&D) Service, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
- VA HSR&D Precision Monitoring for Quality Improvement (PRIS-M) QUERI Center, Indianapolis, Indiana, USA
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Cadilhac DA, Sheppard L, Kim J, Tan E, Gao L, Sookram G, Dewey HM, Bladin CF, Moodie M. Economic Evaluation Protocol and Statistical Analysis Plan for the Cost-Effectiveness of a Novel Australian Stroke Telemedicine Program; the Victorian Stroke Telemedicine (VST) program. Front Neurol 2021; 11:602044. [PMID: 33584501 PMCID: PMC7873861 DOI: 10.3389/fneur.2020.602044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine can address limited access to medical specialists in rural hospitals. Stroke provides an important case study because: it is a major cause of disease burden; effective treatments to reduce disability (e.g., thrombolysis) can be provided within the initial hours of stroke onset; careful selection of patients is needed by skilled doctors to minimize adverse events from thrombolysis; and there are major treatment gaps (only about half of regional hospitals in Australia provide thrombolysis for stroke). Few economic analyses have been undertaken on telestroke and the majority have been simulation models. The aim of this protocol and statistical analysis plan is to outline the methods for the cost-effectiveness evaluation of a large, multicentre acute stroke telemedicine program being conducted in Victoria, Australia. Methods: Using a historical- and prospective-controlled design, we will compare patient-level data obtained in the 12 months prior to the Victorian Stroke Telemedicine (VST) program implementation and during the first 12 months of VST to determine the incremental difference in costs and patient outcomes at 3 and 12 months. Secondary aims include assessing the cost per additional patient receiving intravenous thrombolysis and the cost per additional patient receiving intravenous thrombolysis within 60 min. Tertiary aims include assessing the potential longer-term cost-effectiveness in the second year of the program at the hospitals to determine whether any program benefits are sustained once site coordinators are no longer employed; and modeling the potential net life-time costs and benefits from a societal perspective. Multivariable uncertainty and one-way sensitivity analyses will be performed to assess the robustness of results. Results: Sixteen hospitals participated. Patient-level data collection including 12-month outcomes for the cohorts obtained in the first and second year of the program for each hospital was completed in January 2020. Conclusion: The results from this real-world study with patient-level data will provide high quality evidence of the costs, health benefits and policy implications of telestroke programs, including the potential for application in other locations within Australia or other countries with similar health system delivery and financing.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Lauren Sheppard
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Garveeta Sookram
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Ambulance VIC, Doncaster, VIC, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Bladin CF, Kim J, Bagot KL, Vu M, Moloczij N, Denisenko S, Price C, Pompeani N, Arthurson L, Hair C, Rabl J, O'Shea M, Groot P, Bolitho L, Campbell BCV, Dewey HM, Donnan GA, Cadilhac DA. Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program. Med J Aust 2020; 212:371-377. [DOI: 10.5694/mja2.50570] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Chris F Bladin
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Ambulance Victoria Melbourne VIC
| | - Joosup Kim
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
| | - Kathleen L Bagot
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
| | | | | | | | | | - Nancy Pompeani
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
| | | | | | | | | | | | | | - Bruce CV Campbell
- Melbourne Health Melbourne VIC
- Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of Melbourne Melbourne VIC
| | | | - Geoffrey A Donnan
- Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of Melbourne Melbourne VIC
| | - Dominique A Cadilhac
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
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Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature. J Neurol 2020; 268:2723-2734. [PMID: 32206899 DOI: 10.1007/s00415-020-09803-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS This review examined factors that delay thrombolysis and what management strategies are currently employed to minimise this delay, with the aim of suggesting future directions to overcome bottlenecks in treatment delivery. METHODS A systematic review was performed according to PRISMA guidelines. The search strategy included a combination of synonyms and controlled vocabularies from Medical Subject Headings (MeSH) and EmTree covering brain ischemia, cerebrovascular accident, fibrinolytic therapy and Alteplase. The search was conducted using Medline (OVID), Embase (OVID), PubMed and Cochrane Library databases using truncations and Boolean operators. The literature search excluded review articles, trial protocols, opinion pieces and case reports. Inclusion criteria were: (1) The article directly related to thrombolysis in ischaemic stroke, and (2) The article examined at least one factor contributing to delay in thrombolytic therapy. RESULTS One hundred and fifty-two studies were included. Pre-hospital factors resulted in the greatest delay to thrombolysis administration. In-hospital factors relating to assessment, imaging and thrombolysis administration also contributed. Long onset-to-needle times were more common in those with atypical, or less severe, symptoms, the elderly, patients from lower socioeconomic backgrounds, and those living alone. Various strategies currently exist to reduce delays. Processes which have achieved the greatest improvements in time to thrombolysis are those which integrate out-of-hospital and in-hospital processes, such as the Helsinki model. CONCLUSION Further integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
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Bagot K, Moloczij N, Arthurson L, Hair C, Hancock S, Bladin CF, Cadilhac DA. Nurses' Role in Implementing and Sustaining Acute Telemedicine: A Mixed-Methods, Pre-Post Design Using an Extended Technology Acceptance Model. J Nurs Scholarsh 2019; 52:34-46. [PMID: 31508882 DOI: 10.1111/jnu.12509] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Technology-based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non-nurses. DESIGN A mixed-methods, pre-post design with implementation of a new acute stroke telemedicine service. METHODS A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014-2017). Open-ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010-2011) was completed to provide greater explanatory detail. FINDINGS Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non-nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non-nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). CONCLUSIONS Important factors for acute stroke telemedicine varied between nurses and non-nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non-nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. CLINICAL RELEVANCE Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence-based implementation strategies must be tailored over time, and between nurses and non-nurses, to ensure initial uptake and ongoing use.
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Affiliation(s)
- Kathleen Bagot
- Research Fellow, Public Health: Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne University, Melbourne, Australia
| | - Natasha Moloczij
- Program Manager-Nurse-led Research, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Lauren Arthurson
- Stroke Coordinator & Allied Health Manager, Inpatient Rehabilitation, Echuca Regional Hospital, Echuca, Australia
| | - Casey Hair
- VST Site Coordinator, Ballarat Health Service, Ballarat, Australia
| | - Shaun Hancock
- Research Officer, Public Health: Stroke Division, The Florey Institute of Neuroscience & Mental Health, Melbourne University, Melbourne, Australia
| | - Christopher F Bladin
- Director, Victorian Stroke Telemedicine Program, Ambulance Victoria, Blackburn, Australia
| | - Dominique A Cadilhac
- Head, Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Brecthel L, Gainey J, Penwell A, Nathaniel TI. Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients. BMC Neurol 2018; 18:215. [PMID: 30577762 PMCID: PMC6302528 DOI: 10.1186/s12883-018-1204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients. METHODS Structured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model. RESULTS The non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025-1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16-3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961-0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032-0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223-0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046-0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322-12.611, P = 0.014). CONCLUSION The direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.
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Affiliation(s)
- Leanne Brecthel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Jordan Gainey
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Alexandria Penwell
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina, School of Medicine-Greenville, Greenville, SC, 29605, USA.
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10
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Bagot KL, Cadilhac DA, Bladin C. Clot retrieval and acute stroke care. Med J Aust 2018; 207:361. [PMID: 29020909 DOI: 10.5694/mja17.00515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Kathleen L Bagot
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
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11
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Bagot KL, Moloczij N, Barclay-Moss K, Vu M, Bladin CF, Cadilhac DA. Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine. J Telemed Telecare 2018; 26:79-91. [PMID: 30193566 DOI: 10.1177/1357633x18792380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Technology-based innovation requires long-term changes to workforce routines, otherwise practices will not be sustained. The aim of this study was to identify influential factors in the ongoing use of an acute stroke telemedicine programme. METHODS A new acute stroke telemedicine programme in a regional hospital receiving 375 patients with stroke or transient ischaemic attack per year was used as an exploratory case study. Semi-structured interviews with acute care and emergency department clinicians (n = 25) were conducted at two time-points: after a six-month pilot and then after a further 12-month implementation phase. Interviews (between 12-60 min) were recorded, transcribed and analysed inductively using descriptive thematic analysis. Reported barriers and facilitators were compared with those previously reported pre-implementation (deductive analysis) to identify changes over time. Using an implementation framework and a behaviour change taxonomy, strategies were developed to address influential factors on sustainability. RESULTS New facilitators were identified including hospital system changes, benefits to clinicians and telemedicine becoming standard practice. New and ongoing barriers included infrequent use, competing demands and the continued resistance to a specific treatment. DISCUSSION Understanding the factors supporting a health service in successfully implementing change can accelerate population benefits. The innovation itself may include barriers to be addressed, and barriers and facilitators can change over time. Individual attitudes remain critical to initial and ongoing success. Strategies proposed included promoting benefits across the organisation and allaying uncertainties with site-specific evidence. The effectiveness of these strategies, however, needs to be evaluated. Strategies sustaining change post-implementation should be considered.
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Affiliation(s)
- Kathleen L Bagot
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,Department of Medicine, Monash University, Australia
| | | | - Karen Barclay-Moss
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | | | - Christopher F Bladin
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,Department of Medicine, Monash University, Australia.,Ambulance Victoria, Australia.,Box Hill Hospital, Eastern Health, Australia
| | - Dominique A Cadilhac
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,Department of Medicine, Monash University, Australia
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12
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Bagot KL, Cadilhac DA, Kim J, Vu M, Savage M, Bolitho L, Howlett G, Rabl J, Dewey HM, Hand PJ, Denisenko S, Donnan GA, Bladin CF. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. J Telemed Telecare 2018; 23:850-855. [PMID: 29081268 DOI: 10.1177/1357633x17734004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.
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Affiliation(s)
- Kathleen L Bagot
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Dominique A Cadilhac
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Joosup Kim
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia.,2 School of Clinical Sciences at Monash Health, 22457 Monash University , Australia
| | - Michelle Vu
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Mark Savage
- 3 Bendigo Health, Medical Services, 22457 Monash University , Australia
| | - Les Bolitho
- 4 Internal Medicine Department, 72537 Northeast Health Wangaratta , Australia
| | - Glenn Howlett
- 5 Medical Services, Echuca Regional Health, Australia
| | - Justin Rabl
- 6 Clinical Services, Goulburn Valley Health, Australia
| | - Helen M Dewey
- 7 Eastern Health Clinical School, 22457 Monash University , Australia
| | - Peter J Hand
- 8 Department of Medicine and Neurology, Royal Melbourne Hospital, Australia
| | - Sonia Denisenko
- 9 Victorian Stroke Clinical Network, Department of Health and Human Services, Australia
| | - Geoffrey A Donnan
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Christopher F Bladin
- 1 Stroke Division, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
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13
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Cadilhac DA, Fisher R, Bernhardt J. How to do health services research in stroke: A focus on performance measurement and quality improvement. Int J Stroke 2018; 13:166-174. [PMID: 29299958 DOI: 10.1177/1747493017750924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The objective of this "How to" research series article is to provide guidance on getting started in Health Services Research. The purpose of health services research is to contribute knowledge that can be used to help improve health systems and clinical services through influencing policy and practice. The methods used are broad, have varying levels of rigor, and may require different specialist skills. This paper sets out practical steps for undertaking health services research. Importantly, use of the highlighted techniques can identify solutions to address inadequate knowledge translation or promote greater access to evidence-based stroke care to optimize patient outcomes.
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Affiliation(s)
- Dominique A Cadilhac
- 1 Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,2 Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Rebecca Fisher
- 3 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Julie Bernhardt
- 2 Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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14
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Blacker DJ. Penumbral freeze: travel distance and delays provide an opportunity to study prerecanalization therapy neuroprotection. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- David J Blacker
- Department of Neurology, Charles Gairdner Hospital & The Perron Institute for neurological & translational science, Nedlands, Australia
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15
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Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, Dewey HM, Emsley HCA, Davies DP, Day E, Ford GA, Price CI, May CR, McLoughlin ASR, Gibson JME, Lightbody CE. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017; 17:751. [PMID: 29157233 PMCID: PMC5697163 DOI: 10.1186/s12913-017-2694-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Methods Specialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Results Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Conclusion Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.
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Affiliation(s)
- Kathleen L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia. .,University of Central Lancashire, Preston, UK. .,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Dominique A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Christopher F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Caroline L Watkins
- University of Central Lancashire, Preston, UK.,Australian Catholic University, Sydney, Australia
| | - Michelle Vu
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - D Paul Davies
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - Elaine Day
- Lancashire and South Cumbria Strategic Clinical Network, Greater Manchester, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust and Division of Medical Sciences, University of Oxford, Oxford, UK
| | - Christopher I Price
- Northumbria Healthcare NHS Foundation Trust, Newcastle, UK.,Newcastle University, Newcastle, UK
| | - Carl R May
- University of Southampton, Southampton, UK
| | | | | | - Catherine E Lightbody
- University of Central Lancashire, Preston, UK.,Australian Catholic University, Sydney, Australia
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16
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Bagot KL, Cadilhac DA, Kim J, Vu M, Bladin CF. Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology 2017; 89:1648-1649. [PMID: 28993526 DOI: 10.1212/wnl.0000000000004478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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18
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Bray JE, Denisenko S, Campbell BCV, Stephenson M, Muller J, Hocking G, Hand PJ, Bladin CF. Strategic framework improves access to stroke reperfusion across the state of Victoria Australia. Intern Med J 2017; 47:923-928. [DOI: 10.1111/imj.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/11/2017] [Accepted: 05/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Janet E. Bray
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Sonia Denisenko
- Department of Health and Human Services; Victorian Stroke Clinical Network; Melbourne Victoria Australia
| | - Bruce C. V. Campbell
- Department of Medicine and Neurology; Melbourne Brain Centre, Royal Melbourne Hospital and The University of Melbourne; Melbourne Victoria Australia
| | - Michael Stephenson
- Ambulance Victoria; Melbourne Victoria Australia
- Department of Community Health and Paramedic Practice; Monash University; Melbourne Victoria Australia
| | - Jason Muller
- Ambulance Victoria; Melbourne Victoria Australia
| | | | - Peter J. Hand
- Department of Health and Human Services; Victorian Stroke Clinical Network; Melbourne Victoria Australia
- Department of Medicine and Neurology; Melbourne Brain Centre, Royal Melbourne Hospital and The University of Melbourne; Melbourne Victoria Australia
| | - Christopher F. Bladin
- The Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Eastern Health Clinical School; Monash University; Melbourne Victoria Australia
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19
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Bagot KL, Bladin CF, Vu M, Kim J, Hand PJ, Campbell B, Walker A, Donnan GA, Dewey HM, Cadilhac DA. Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective. J Telemed Telecare 2017; 22:489-494. [PMID: 27799453 DOI: 10.1177/1357633x16673695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 12/25/2022]
Abstract
We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community.
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Affiliation(s)
- Kathleen L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia .,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Christopher F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - Michelle Vu
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Joosup Kim
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Peter J Hand
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Bruce Campbell
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia.,Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Alison Walker
- Medical Services, Mildura Base Hospital, Mildura, Australia
| | - Geoffrey A Donnan
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Helen M Dewey
- Medical Services, Mildura Base Hospital, Mildura, Australia
| | - Dominique A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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20
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Bagot KL, Bladin CF, Cadilhac DA. A cautionary note to authors on the selection and use of keywords. J Telemed Telecare 2016; 23:752-753. [DOI: 10.1177/1357633x16686549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kathleen L Bagot
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Christopher F Bladin
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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21
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Bagot KL, Cadilhac DA, Hand PJ, Vu M, Bladin CF. Telemedicine expedites access to optimal acute stroke care. Lancet 2016; 388:757-8. [PMID: 27560271 DOI: 10.1016/s0140-6736(16)31360-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Kathleen L Bagot
- Division of Public Health/Stroke, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia.
| | - Dominique A Cadilhac
- Division of Public Health/Stroke, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Peter J Hand
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Michelle Vu
- Division of Public Health/Stroke, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, VIC, Australia
| | - Christopher F Bladin
- Division of Public Health/Stroke, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia
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22
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Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2016; 45:957-64. [PMID: 25904209 DOI: 10.1111/imj.12793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia. AIM Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations. METHODS Purposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding. RESULTS The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases. CONCLUSIONS Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.
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Affiliation(s)
- N Moloczij
- Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia
| | - I Mosley
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - K M Moss
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - K L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - C F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - D A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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23
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Bladin CF, Molocijz N, Ermel S, Bagot KL, Kilkenny M, Vu M, Cadilhac DA. Victorian Stroke Telemedicine Project: implementation of a new model of translational stroke care for Australia. Intern Med J 2015; 45:951-6. [DOI: 10.1111/imj.12822] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. F. Bladin
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Eastern Health Clinical School; Monash University; Melbourne Victoria Australia
| | - N. Molocijz
- Medical and Cognitive Research Unit; Austin Health; Melbourne Victoria Australia
| | - S. Ermel
- Bendigo Health; Bendigo Victoria Australia
| | - K. L. Bagot
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - M. Kilkenny
- Translational Public Health Unit; Stroke and Ageing Research Centre; Department of Medicine; School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
| | - M. Vu
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - D. A. Cadilhac
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Translational Public Health Unit; Stroke and Ageing Research Centre; Department of Medicine; School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
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24
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Blacker DJ, Hankey GJ. Pre-hospital stroke management: an Australian perspective. Intern Med J 2014; 44:1151-3. [PMID: 25442754 DOI: 10.1111/imj.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/12/2014] [Indexed: 01/01/2023]
Affiliation(s)
- D J Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia; West Australian Neurosciences Research Institute, Perth, Western Australia, Australia
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25
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Cadilhac DA, Vu M, Bladin C. Experience with scaling up the Victorian Stroke Telemedicine programme. J Telemed Telecare 2014; 20:413-8. [DOI: 10.1177/1357633x14552389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telemedicine can be used to increase access to stroke thrombolysis in rural hospitals but is not widely used for this purpose in Australia. The Victorian Stroke Telemedicine (VST) programme commenced in one hospital in 2011, and is being expanded to a further 15 hospitals. The present study summarises progress in scaling up the VST programme from one to four hospitals. Patient and clinical consultation quantitative data obtained from 1 March 2014 until 30 June 2014 were reviewed. By August 2014, the VST programme was operational at the four hospital sites. During the period 1 March 2014 to 30 June 2014, a total of 42 patients (14 female) at three hospitals received a VST consultation. Seven patients were recommended to receive tPA, and six were treated. Of the 42 initial calls made to the VST, 14 (33%) resulted in a video consultation and 28 (67%) were telephone only. For the 28 cases receiving a telephone-only consultation, 21 (75%) were deemed not to require a video consultation by the neurologist. The remaining seven consultations (25%) were telephone-only due to technical problems experienced with the telemedicine equipment. The preliminary results from the expansion of the VST programme to the three hospitals provides evidence of appropriate use, with almost 70% of the telemedicine consultations resulting in a diagnosis of stroke.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Michelle Vu
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Christopher Bladin
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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26
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Andrew NE, Hankey GJ, Cadilhac DA. Evidence-to-practice gaps in post-stroke management: a focus on care in a stroke unit and anticoagulation to prevent death, disability and recurrent stroke. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: The global burden of stroke is large. Over the last 15 years significant advances have been made to improve acute stroke care and prevention management providing the ability to mitigate much of this burden. In this article, we describe the importance of two main elements of stroke care: stroke units to reduce death and disability and anticoagulation therapy to prevent recurrent, often fatal or disabling, cardioembolic stroke. We also describe the issues related to translating these interventions into practice and the related economic implications. Despite the proven effectiveness and cost–effectiveness of these and other interventions, many people experiencing stroke are not receiving these interventions. Effective evidence translation initiatives and routine monitoring of healthcare is needed to address important gaps in stroke management in promoting societal well-being.
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Affiliation(s)
- Nadine E Andrew
- Translational Public Health Unit, Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, 1/43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Graeme J Hankey
- School of Medicine & Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia
| | - Dominique A Cadilhac
- Translational Public Health Unit, Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, 1/43-51 Kanooka Grove, Clayton, VIC 3168, Australia
- Florey Institute of Neuroscience & Mental Health, 245 Burgundy St, Heidelberg, VIC 3084, Australia
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27
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Bladin C. Stroke thrombolysis:per ardua, ad astra…. Intern Med J 2014; 44:111-3. [DOI: 10.1111/imj.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/06/2013] [Indexed: 01/19/2023]
Affiliation(s)
- C. Bladin
- The Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Eastern Health-Monash University; Melbourne Victoria Australia
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