Rural health
According to the Centers for Disease Control, over 46 million Americans live in a rural setting. Rural areas are less likely to have access to providers that specialize in a particular field, such as Vascular Neurologists who specialize in caring for people with stroke. In fact, studies have shown that people who live in rural settings are more likely to die from stroke than those who live in non-rural areas.
This, in part, is due to difficulty accessing routine healthcare and specialty services. Hospitals may be very remote and require long travel distances that are not feasible for the average person. The healthcare providers who are physically present may be stretched too thin or not have the expertise required for modern stroke care.
What is telehealth?
Telehealth is when communication tools are used to provide medical care when the patient and the provider are not in the same physical location. Telehealth can also be known as telemedicine.
Telehealth can be as simple as using a phone for conversation, but the addition of video technology increases the efficacy of evaluations significantly. Telehealth providers such as NeuroX use highly sophisticated encrypted services to ensure a solid connection that maintains privacy and security throughout the visit. The service can be accessed through any internet-connected device with a web browser, such as a tablet, smart phone, or personal computer.
In certain settings, such as an emergency room or rehab center, telehealth can also involve a mobile robotic interface with a screen, camera, speakers, microphones, and even robotic arms to test strength. These devices allow the Neurologist to provide a neurological examination and obtain a detailed history in order to ensure the best care. In some cases, similar setups are even integrated into ambulances. Both sound and audio can be used, and the person can see their medical provider to make a personal connection.
Telehealth care still involves standardized documentation in an electronic medical record that can be reviewed by the person’s other medical providers, ensuring that the whole medical team is on the same page.
Medical providers who provide care through telehealth are fully credentialed and licensed to provide medical care to the patients receiving the service. These services can be billed through medical insurance or direct reimbursement. NeuroX offers not only telehealth access to a medical provider, but also a full team including medical assistants, community support specialists, laboratory and radiology services, technical support, and nursing staff. These services are offered every day of the year, regardless of whether it is a weekday or weekend, day or night, or if your medical needs happen to land on a holiday.
How is telehealth used in stroke care?
This cutting-edge healthcare technology brings the expert to any area, regardless of population count or community resources. This positively impacts stroke care in multtimelines:emergent diagnosis of stroke and interventions to improve outcome
Acute stroke management – or evaluation and treatment of damage to the brain from lack of blood flow that occurs immediately after symptom onset – is a rapidly evolving field that requires both nuanced expertise and rapid and immediate decision making. In a world where thrombolytics (clot busting medications that can improve outcome but also have a major risk of bleeding) and thrombectomy (a surgical procedure to remove a clot that can save brain tissue in the correct setting or has risk of bleeding in the wrong patient) have to be rapidly considered with a multitude of factors. These factors include: when the symptoms started, medical history, medication exposure, lab testing, exam findings, and evolving evidence-based guidelines, which require true experts helping these patients to have the best outcome. Furthermore, these decisions must be made quickly, as the saying goes “time is brain”, and up to 1.9 million neurons can die in the brain each minute that a stroke goes without treatment.
Telehealth technology can allow a provide – even at a small rural hospital – to immediately involve a Stroke Neurologist in a patient’s care, improving quality of care and outcomes. This offers immense value to the hospital that may not be able to support multiple specialists themselves, the emergency medicine provider who does not have the specialized training, the family of the patient who can feel confident their loved one is receiving the best care, and – most importantly – the person who is having a stroke and can get the best treatment, regardless of their zip code.
The days following stroke are also immensely important. The average family practice provider may not be familiar with the nuances of management in this unique setting. Blood pressure numbers are often customized to the patient’s stroke treatment and stroke location. Medications such as antiplatelets or anticoagulants will be started depending on a multitude of factors, including stroke cause, stroke size, or other medications received. Appropriate tests should be considered to evaluate heart function, the state of the blood vessels of the head or neck, blood work that can evaluate the likelihood of blood clots forming, and more to best help find the cause of stroke and how to prevent another. The stroke patient and their family benefit from guidance on what to expect and the next steps. In rural hospitals with Stroke Neurologists, these aspects all too often go unaddressed. However, stroke patients in rural areas no longer need to have suboptimal care in the days following stroke. Telehealth can be used for the Stroke Neurologist to evaluate the patient daily in order to ensure the best care.
After hospitalization, many stroke patients then undergo a period of rehabilitation with physical therapy, occupational therapy, and / or speech therapy. Depending on multiple factors, this may occur in the patient’s home, at a skilled nursing rehab center, or at a rehab hospital. Many skilled nursing rehab centers or rehab hospitals may have access to a primary care provider but do not have all necessary specialists on staff or available
In these cases, NeuroX can offer telehealth services that bring the stroke expertise to the patient whenever needed during rehab. If a person returns home immediately after the hospital and that home happens to be in a rural area, they may feel isolated or without expert support. Similar to rehab centers, telehealth can be used at home through a smart device or personal computer to bring the expertise to their home. The Stroke Neurologist can review and interpret tests that have been performed, educate the person and family on lifestyle changes that can help prevent stroke, watch for any side effects from medications, ensure that no delayed complications occur, and optimize care to prevent another stroke event. Despite earlier treatment, some stroke survivors may be left with mobility difficulties that limit the ability to leave the home, use a car or public transportation, or take stairs in or out of a building. Telehealth offers a way to receive care without these physical barriers.
Why not just bring the rural stroke patient to an urban hospital?
Now that you understand the difficulties for the average rural person to receive the highest quality stroke care without telehealth, you may be asking why these patients should not simply be brought to an urban hospital. While this occasionally must be considered when certain surgical procedures are needed where the rural area does not have the surgeon or equipment, this is actually not possible for most stroke patients due to the unique nature of stroke.
As mentioned above, stroke care is profoundly time sensitive. When nearly 2 million neurons die every minute while a person is experiencing stroke, the patient cannot afford to take 1 or 2 hours to be driven or flown to a big-city hospital before their stroke care is started. At this point, the patient will have had more damage done to the brain and may no longer be a candidate for the aggressive therapies that can be brain-saving. Furthermore, transfers to distant hospitals displace the patient from their existing support systems and isolate them from their family or friends. This can lead to a person who is already suffering a stroke to be without their loved ones, or result in massive costs in transportation, fuel, meals, and lodging for visitors and loved ones.
Telehealth offers an elegant solution in our modern world.
Telehealth offers an elegant solution in our modern world.
Beyond the benefits mentioned above unique to rural medicine and applicable to stroke care, telehealth offers several other benefits.In the setting of the Covid-19 infectious pandemic, telehealth offers a way to receive high quality health care without exposure to illness from other people.
Beyond the benefits mentioned above unique to rural medicine and applicable to stroke care, telehealth offers several other benefits.
In the setting of the Covid-19 infectious pandemic, telehealth offers a way to receive high quality health care without exposure to illness from other people.
In our busy lifestyle, telehealth avoids commuting time, dangerous travel, or the need to arrange childcare services for a medical visit.
Telehealth also offers an efficient way to avoid long wait times that often are present when seeking medical care. Rather than having to wait 4 months to see a specialist in a city far away, a specialist can see you within a week, right in the comfort of your own home.
Telehealth offers expert care to every patient, every place, every day.
Brad Haveman-Gould, MHS, PA-C
Neurology Physician Assistant
