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Try out PMC Labs and tell Musc looking for a dl bj what you think. Learn More. Our sample includes 4, South Carolinians. These increases in access are especially ificant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can greatly increase access to care for residents throughout South Carolina.
Stroke is a leading cause of death and disability in the United States Thom et al. South Carolina has especially high stroke incidence and mortality rates, particularly in younger and African American patients when compared to the rest of the country. When administered appropriately, rtPA ificantly reduces the long term disability and physical damage that can follow AIS Alberts et al.
In fact, Capampangan et al. Current challenges related to geography and resource limitations can influence patient access to stroke care and rtPA Wang et al. Several groups, including the brain attack coalition BAC and the American Stroke Association ASAhave established guidelines for the development of primary stroke centers PSCswhich are hospitals that meet specific requirements for access to expertise, necessary hospital-based resources, and process criteria that are required to track appropriate use of rtPA.
While being seen by a neurologist is not strictly necessary, the application of the selection criteria for rtPA use and CT interpretation are sufficiently complex that access to experienced stroke physicians is of value Webb et al. research has indicated that deated stroke units and certifications along with specified stroke protocols can result in more appropriate rtPA use, increased adherence to post-rtPA protocols, and improved patient outcomes Stroke Unit Trialists Collaboration, ; Goldstein et al.
Although rtPA can and is given in hospitals without PSC deation, the required deations and protocols can help ensure that the most effective care is given to stroke patients through standardization and the required use of stroke expertise. Although not proven, evidence suggests that PSC deation may improve the processes of care to allow for the optimal use of rtPA for stroke patients Stradling et al.
One way to make stroke expertise available is through the use of telemedicine. Because of the expertise that may be required to administer rtPA, REACH allows small hospitals without on-site neurologists to provide this level of care to stroke patients in a cost effective way. Using telemedicine to treat stroke may overcome barriers to high quality care that exist because of a shortage of stroke experts and the lack of PSCs in rural communities Schwab et al. Additionally, Carr et al. Telemedicine uses two-way real-time video conferencing with access to radiology images.
In light of this, the South Carolina legislature asked the Department of Health and Environmental Control to study stroke and make recommendations for the development of a stroke system of care South Carolina Legislature 1. Critical to the development Musc looking for a dl bj such a system are the established efforts to treat stroke acutely, including the use of rtPA.
research conducted by the tri-state stroke network TSSN and the centers for disease control CDC has examined the impact and prevalence of stroke using a similar approach and found that there is limited access to rtPA treatment in the rural coastal plains that has many of the highest stroke death rates in the region.
We studied U. We consider this care to include the possible treatment with rtPA, which has been shown to be more likely given in a deated stroke center with selective triage Gropen et al. The analysis was conducted in two ways. The data for this analysis came from the Census population totals for Census Tracts in South Carolina. This study describes an important finding related to stroke care. The use of telemedicine can increase access for vulnerable populations who may seek emergency stroke care in small hospitals without PSC deation. The large increases in access to expert stroke care for South Carolinians demonstrate the potential impact that the use of telemedicine may have in a geographic area.
Attaining and maintaining PSC deation status is complex and costly, especially for smaller hospitals Smith et al. Because of the health disparities that exist in the incidence, diagnosis, and treatment of stroke related to race, age, gender, and geographic location, improvements must be made to increase access to standardized care for stroke patients in an Musc looking for a dl bj way.
Our study does have limitations. The study is based on census data but we are not aware of major demographic changes in the last decade that would undermine the importance of our findings. Another limitation of our study is the fact that we only measure access to expert stroke care. While we do not imply that access always equals treatment, we recognize that having access to expert stroke care is a necessary precursor to treatment. Thus, we cannot conclude nor infer the of patients with access who will be treated with rtPA.
Since healthcare resources and expertise may be limited in smaller hospitals and rural areas, it is important for organizations to explore relationships and mechanisms of cooperation with larger, advanced organizations with greater resources and expertise.
By connecting stroke experts at MUSC to patients at smaller community hospitals, the access to high quality care has increased. The rapid and substantial shift in access, documented in this paper, could only be accomplished by telemedicine. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
National Center for Biotechnology InformationU. Journal List Front Neurol v. Front Neurol. Published online Mar Abby Swanson Kazley1 Rebecca C. Wilkerson2 Edward Jauch3 and Robert J. Rebecca C. Robert J. Author information Article notes Copyright and information Disclaimer. This article was submitted to Frontiers in Teleneurology, a specialty of Frontiers in Neurology.
Received Oct 19; Accepted Mar 6. This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercialwhich permits non-commercial use, distribution, and reproduction in other forums, provided the original authors and source are credited.
This article has been cited by other articles in PMC. Keywords: access to care, rtPA, telestroke, reducing disparities in access. Introduction Stroke is a leading cause of death and disability in the United States Thom et al. Materials and Methods We studied U. Open in a separate window. Figure 1.
All data are based on Census s. Discussion This study describes an important finding related to stroke care.
Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References Alberts M. Recommendations for the Establishment of Primary Stroke Centers. Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic.
Neurologist 15— Half of Americans live more than an hour away from lifesaving stroke care. Access to emergency care in the United States. Stroke telemedicine. Mayo Clin. Neurology 64— VA Stoke Study: neurologist care is associated with increased testing but improved outcomes.
Neurology 6888— Thrombolysis with alteplase 3 to 4.
Telestroke: extending stroke expertise into under served areas. Lancet Neurol. REACH: clinical feasibility of a rural telestroke network. Stroke 36— Implementing a stroke system of care in a rural hospital: a case report from Granite Falls. Geographic and sociodemographic disparities in drive times to certified stroke centers in the tri-state stroke network region — North Carolina, South Carolina, and Georgia. Eligibility for recombinant tissue plasminogen activator in acute ischemic stroke: a population-based study. Stroke 35e27—e US geographic distribution of rtPA utilization by hospital for acute ischemic stroke.
Stroke 40— The geographic variation in stroke incidence in two areas of Southeastern stroke belt: the Anderson and Pee Dee stroke study. Stroke 29— Safety issues and concerns for the neurological patient in the emergency department.Musc looking for a dl bj
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