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Goh R, Hillier S, Kelly TL, Worley A, Dixon K, Kurunawai C, Tan A, Mahadevan J, Willcourt M, Jannes J, Kleinig T. Implementation of the South Australian Regional Telestroke service is associated with improved care quality and lower stroke mortality: A retrospective cohort study. Aust J Rural Health 2023; 31:878-885. [PMID: 37350539 DOI: 10.1111/ajr.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Stroke in Regional Australia may have worse outcomes due to difficulties accessing optimal care. The South Australian Regional Telestroke service aimed to improve telestroke neurologist access, supported by improved ambulance triage. OBJECTIVE To assess stroke care quality and patient mortality pre- and postimplementation of a vascular neurologist-led Telestroke service. DESIGN Historically controlled mixed methods cohort study comparing key quality indicators and patient mortality (6 months pre- vs. 18 months postimplementation date [4 June 2018]) at the three major South Australian regional stroke centres. The primary outcome was 13 care quality indicators as a combined composite risk-adjusted score, and the secondary outcome was risk-adjusted mortality at 12-month postadmission. FINDINGS On an annualised basis, of 189 patients with stroke, more were admitted postintervention to the regional stroke centres than in the control period (158 [annualised rate 105.3, 95% CI 86.2-127.4] vs. 31 [annualised rate 62.0, 95% CI 47.5-79.5]) Baseline patient characteristics were similar in both periods. Post-implementation, median last-known-well time to presentation (3.5 h [IQR 1.6-17] vs. 2.0 [IQR 1-14]; p = 0.46) and door to needle times (121 min [IQR 97-144] vs. 90 [IQR 75-138]; p = 0.65) were not significantly lower but an improvement in the combined composite quality score was observed (0.069 [95% CI 0.004-0.134; p = 0.04]), reflecting individual improvements in some quality indicators. Mortality at 12-month postimplementation was substantially lower postimplementation (prechange 23% vs. postchange 13% [hazard ratio 0.58 (95% CI 0.44-0.76; p < 0.001)]). CONCLUSION Implementation of a South Australian Regional Telestroke service was associated with improved care metrics and lower mortality.
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Affiliation(s)
- Rudy Goh
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Susan Hillier
- University of South Australia, Adelaide, South Australia, Australia
| | - Thu-Lan Kelly
- University of South Australia, Adelaide, South Australia, Australia
| | - Anthea Worley
- University of South Australia, Adelaide, South Australia, Australia
| | - Karen Dixon
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig Kurunawai
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Aaron Tan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Mahadevan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Jim Jannes
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
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Jayasinghe S, Flies EJ, Soward R, Kendal D, Kilpatrick M, Holloway TP, Patterson KAE, Ahuja KDK, Hughes R, Byrne NM, Hills AP. A Spatial Analysis of Access to Physical Activity Infrastructure and Healthy Food in Regional Tasmania. Front Public Health 2021; 9:773609. [PMID: 34926390 PMCID: PMC8671161 DOI: 10.3389/fpubh.2021.773609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Prevalence of physical inactivity and obesity continues to increase in regional areas such as North-West (NW) Tasmania and show no signs of abating. It is possible that limited access to physical activity infrastructure (PAI) and healthier food options are exacerbating the low levels of habitual physical activity and obesity prevalence in these communities. Despite a burgeoning research base, concomitant exploration of both physical activity and food environments in rural and regional areas remain scarce. This research evaluated access (i.e., coverage, variety, density, and proximity) to physical activity resources and food outlets in relation to socioeconomic status (SES) in three NW Tasmanian communities. In all three study areas, the PAI and food outlets were largely concentrated in the main urban areas with most recreational tracks and natural amenities located along the coastline or river areas. Circular Head had the lowest total number of PAI (n = 43) but a greater proportion (30%) of free-to-access outdoor amenities. There was marked variation in accessibility to infrastructure across different areas of disadvantage within and between sites. For a considerable proportion of the population, free-to-access natural amenities/green spaces and recreational tracks (73 and 57%, respectively) were beyond 800 m from their households. In relation to food accessibility, only a small proportion of the food outlets across the region sells predominantly healthy (i.e., Tier 1) foods (~6, 13, and 10% in Burnie, Circular Head and Devonport, respectively). Similarly, only a small proportion of the residents are within a reasonable walking distance (i.e., 5–10 min walk) from outlets. In contrast, a much larger proportion of residents lived close to food outlets selling predominantly energy-dense, highly processed food (i.e., Tier 2 outlets). Circular Head had at least twice as many Tier 1 food stores per capita than Devonport and Burnie (0.23 vs. 0.10 and 0.06; respectively) despite recording the highest average distance (4.35 and 5.66 km to Tier 2/Tier 1 stores) to a food outlet. As such, it is possible that both food and physical activity environment layouts in each site are contributing to the obesogenic nature of each community.
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Affiliation(s)
- Sisitha Jayasinghe
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Emily J Flies
- School of Natural Sciences, University of Tasmania, Hobart, TAS, Australia.,Healthy Landscapes Research Group, University of Tasmania, Hobart, TAS, Australia
| | - Robert Soward
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Dave Kendal
- Healthy Landscapes Research Group, University of Tasmania, Hobart, TAS, Australia.,School of Geography, Planning and Spatial Sciences, University of Tasmania, Hobart, TAS, Australia
| | - Michelle Kilpatrick
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Timothy P Holloway
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Kira A E Patterson
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Kiran D K Ahuja
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Roger Hughes
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nuala M Byrne
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Andrew P Hills
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Abstract
BACKGROUND Regional and remote areas are often disadvantaged in terms of access to palliative care services. The impact of reduced access to services on people living in regional or remote areas of Australia is poorly understood. OBJECTIVE Identify and examine current literature relating to the palliative care experiences of adults living in regional and remote areas of Australia. METHODS CINAHL, Medline, PubMed, Cochrane Review Library and grey literature were searched using a combination of keywords. A thematic analysis was applied. RESULTS Thirteen articles were included in the final review. Poor access, relocation and hardship were identified as issues affecting participants. CONCLUSION Limited literature was available addressing the palliative care experiences of adults living in regional and remote areas of Australia. To identify and address any inequities in palliative care provision and access, the experiences of palliative care patients living outside major cities need to be examined.
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Affiliation(s)
- Melissa Jansson
- a School of Nursing and Midwifery , Western Sydney University , Locked Bag 1797 Penrith, Sydney , NSW 2751 , Australia
| | - Kathleen Dixon
- a School of Nursing and Midwifery , Western Sydney University , Locked Bag 1797 Penrith, Sydney , NSW 2751 , Australia
| | - Deborah Hatcher
- a School of Nursing and Midwifery , Western Sydney University , Locked Bag 1797 Penrith, Sydney , NSW 2751 , Australia
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