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Stroke is one healthcare issue that requires quick medical attention to avoid death or adverse health outcomes for a patient. Therefore one of the methods that the US government uses to ensure quick access to healthcare services for stroke patients is telehealth. However, less is known concerning the effect of telehealth services in improving the health outcomes of stroke patients. This study aims at evaluating the effectiveness of telehealth in addressing stroke, its outcomes, and its impact on clinical health systems.
Halbert, K., & Bautista, C. (2019). Telehealth Use to Promote Quality Outcomes and Reduce Costs in Stroke Care.Critical Care Nursing Clinics of North America, 31(2), 133–139. Web.
Halbert and Bautista researched to evaluate the impact of telehealth services helping to promote the quality of outcomes and reduce costs of stroke care. Stroke is a severe disease that can cause disability or death if not quickly treated (Halbert & Bautista, 2019). Therefore stroke patients, especially those with ischemic stroke, need quick administering of intravenous thrombolytic within a short period to improve patient outcomes. According to evidence-based studies, patients who receive thrombolytic therapy within the first three hours of symptom onset are likely to have better health outcomes. However, only 3.7% of Americans receive this therapy on time, given that a large population lives in rural areas (Halbert & Bautista, 2019). There are four neurologists for every 100,000 people in the US, and most of them are based in urban areas (Halbert & Bautista, 2019). Transferring patients from the rural is time-consuming and expensive and, therefore, may lead to the lapse of the three-hour treatment window, after which the stroke may damage the brain. This has resulted in corresponding figures showing 20% more stroke deaths in rural areas than in urban areas (Halbert & Bautista, 2019). Therefore, for the people in rural areas to get effective care, they have to rely on telestroke heavily.
American Stroke Association has approved Telestroke for use because it enables tele-neurologists to assess, visualize, converse with a patient, and develop a treatment plan based on the patient’s current history, current presentation, risk factors, and expected outcomes (Halbert & Bautista, 2019). Hospitals that offer telestroke services have a live consultation service with vascular fellowship-trained neurologists, enabling ongoing education and real-time consultation, leading to improved outcomes. This shows that telestroke helps to improve patient outcomes and ensures that their services are more efficient and accessible using telestroke.
Patients with stroke require quick interventions. However, it is important to ensure an accurate stroke diagnosis because many other conditions can imitate stroke symptoms. Therefore, telestroke provides neurologists in the comprehensive stroke hub with data and other relevant information, which helps bedside healthcare practitioners in decision-making (Halbert & Bautista, 2019). The ability of face-to-face examination and real-live transmission of remote images using the Picture Archiving and Communication System (PACS) enables accurate decision-making, hence quick intervention improving the quality of outcomes.
Zerna, C., Jeerakathil, T., & Hill, M. D. (2017). Telehealth for Remote Stroke Management. Canadian Journal of Cardiology, 34(7), 889–896. Web.
Zerna, Jeerakathil, and Hill conducted another study in Canada to determine the effectiveness of telehealth services in diagnosing and treating stroke. Stroke is the fourth leading cause of death and the leading cause of adult disability in Canada (Zerna et al., 2017). This can be attributed to the vast geographical distance between the patients and the neurologist’s expertise. Telestroke is essential in the diagnosis and determination of the effective treatment method. However, for the treatment method to be implemented, it is important to know the main cause of the stroke. One of the tools used in measuring the severity of the stroke is the National Institutes of Health Stroke Scale (NIHSS), which sums up the score from different 11 domains and can range from 0 to 42 (Zerna et al., 2017). A score of five or less shows that it is a minor stroke, while a score of 15 and above may indicate a major stroke (Zerna et al., 2017). A study was conducted to determine the effectiveness and reliability of telehealth in examining patients using NIHSS compared to bedside examination. The study conducted in Germany revealed telehealth to be good to excellent in testing all stroke subgroups within the first six hours (Zerna et al., 2017). Another study conducted in the US found that telestroke does not have a difference of more than three points between bedside testing and using telehealth, showing that it is an accurate method of diagnosis of stroke.
Another important technique is computed tomography, an imaging technique for differentiating between haemorrhagic and ischemic stroke. Studies have been conducted to determine the accuracy and reliability of telehealth services in measuring these services. A study was conducted in Germany whereby two neurologists were given CT scans of nine patients, and their disagreeing rate was 1.7% (Zerna et al., 2017). Another controlled, randomized study was conducted in Arizona, the US, using 54 subjects and found that telestroke services effectively assess, make decisions, and treat stroke. This shows that telestroke services can provide a quick and accurate interpretation of store results. This, in turn, leads to timely treatment, which improves the outcome’s quality. Therefore, telestroke helps in the quick diagnosis and treatment of stroke, hence improving patient outcomes.
Sharma, R., Nalleballe, K., Kapoor, N., Dandu, V., Veerapaneni, K., Yadala, S., Jasti, M., Siddamreddy, S., Onteddu, S., & Brown, A. (2020). Telestroke: A New Paradigm. Ischemic Stroke. Web.
Sharma et al. examine the use of telestroke in the US by analyzing how technology has helped in improving care. In one section, the author examines the effectiveness of telestroke in the management of acute ischemic stroke. The study found that telestroke helps improve healthcare outcomes by eliminating the TPA window, which enables stroke patients to receive adequate care without transporting them to healthcare facilities during the first few hours since the onset of the symptoms significantly affects the outcomes (Sharma et al., 2020). According to the study, the adequate training of NIHHS has proved to be reliable when it is integrated with in-person measurements. Teleradiology enables rapid evaluation of stroke images and helps in the decision-making process. The use of telestroke in rural hospitals helps reduce the time between the onset of symptoms and needle time compared to those in tertiary hospitals. According to a controlled non-blinded randomized study in Germany, patients treated in rural telestroke network hospitals had better outcomes than those treated in rural hospitals’ telestroke capabilities (Sharma et al., 2020). This shows that telestroke is a cost-effective method of reducing the need for transporting patients to urban expensive tertiary hospitals.
The other factor that the study evaluated was telestroke outcomes on patient health. Sharma et al. (2020 ) noted that there were no significant differences between patients treated directly by a neurologist and through telestroke services after 90 days (Sharma et al., 2020). The study also found that the average time between the onset of the symptoms and treatment at the hub site was relatively long compared to the time in telestroke. The earlier the diagnosis and treatment, the decreased the time of stay at the hospital. Therefore, telestroke was found to have rapid diagnosis and treatment, leading to a shorter stay in the hospital and better outcomes. The shorter stay in the hospital led to fewer costs; hence telestroke is cost-effective.
Lindley, R. I. (2020). Telemedicine is improving outcomes for patients with stroke. Medical Journal of Australia, 212(8), 364–365. Web.
To enhance the inclusivity and diversity in this paper, the last article was based on telestroke in Australia. Lindley (2020) conducted a study in Australia to determine how telemedicine improves outcomes for stroke patients. The author evaluates the Victorian Stroke Telemedicine program after its first 12 months and its impact on more than 6000 patients (Lindley, 2020). The results of the study revealed that there was less delay in administering thrombolysis for ischemic stroke patients after the program was rolled out. Additionally, the patients with symptomatic intracranial haemorrhage were reduced from 16% to 4%, and the number of deaths from 20% to 6%, indicating safety improvement (Lindley, 2020). Since not all clinicians can administer thrombolysis, the telestroke helps in facilitating the correct administration of thrombolysis. Computed tomography scanners and public health campaigns have enabled the implementation of thrombolysis by having thrombolysis data for over 80% of patients with stroke (Lindley, 2020). This shows that technology has significantly contributed to the advancement of telstroke.
Early treatment of stroke is important and leads to better health outcomes. A one-minute delay in stroke treatment leads to the loss of 12 kilometers of myelinated fibers, 14 billion synapses, and 1.9 million neurons. The Victorian Stroke Telehealth has enabled to reduce this loss and improve health outcomes by having effective leadership and appropriate financial backup. Therefore, according to this study, telestroke services have helped improve health outcomes for stroke patients.
From the four studies, telestroke has proved to help ensure rapid diagnosis and treatment of stroke. In fact, the study by Sharma found that telestroke was more effective in accessing a neurologist than going to the treatment hub. Telstroke has also proved to have better health outcomes by timely administration of thrombolysis which saves the loss of myelinated fibbers, synapses, and neurons. Finally, the studies have revealed that telestroke is also cost-effective because early diagnosis and treatment leads to quick intervention, decreasing hospital stay. Therefore, telestroke is an effective method in treating stroke and has proved to improve the health outcomes of the patients.
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