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  • 1
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    Abstract TP283: Ambulance Service Use and Associations With Hospital Care and 90-day Outcomes for Acute Stroke: The Australian Stroke Clinical Registry (AuSCR)
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Kurzfassung: Introduction: Hospital arrival via ambulance may influence treatment options and outcomes of acute stroke. A national study for Australia has not previously been reported, and inclusion of long-term outcomes is rare. We aimed to determine differences in the characteristics of patients and their outcomes by route of hospital presentation. Methods: Patient-level data linkage of Australian Stroke Clinical Registry (AuSCR) patients with first-ever strokes between January 2010 and December 2013 (n=40 hospitals) were merged with emergency and hospital admissions, and death records. Multilevel regression models were used to determine associations with hospital care and outcome by type of transport to hospital. Results: Among 9315 patients with first-ever stroke, 5601 (60%) arrived by ambulance (52% male; 79% ischemic). Compared to patients arriving by private transport, those arriving by ambulance were older (ambulance, median 77 vs. private, 72 years; P 〈 0.001), more often had an intracerebral hemorrhage (ICH, ambulance 18% vs 15%; P 〈 0.001), and were unable to walk (proxy for stroke severity: ambulance 73% vs. 50%; P 〈 0.001). Median times to hospital were shorter via ambulance (135 vs. 229 mins; P 〈 0.001), and patients arriving by private transport were less likely to receive acute therapies (rtPA for ischemic stroke, ambulance 16% vs 8%; aspirin 〈 48 hrs, ambulance 75% vs 63%) or swallow screen/assessment (ambulance 89% vs 75%). After accounting for patient/hospital characteristics, compared with patients arriving by private transport, those using ambulances more often received inpatient rehabilitation (aOR 1.57, 95%CI 1.30-1.64), but more often died within 30-days (aOR 1.23) or reported worse quality-of-life at 90-180 days (coefficient: -4.4, 95%CI -7.4 to -1.4). Conclusion: Patients with first-ever stroke who take private transport to hospital experience treatment disadvantages but not worse outcomes. Public education on calling an ambulance for stroke symptoms remains important.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP283
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
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    Longer duration on a Chronic Disease Management plan is associated with long-term adherence to antihypertensive and antithrombotic medications following stroke
    Swansea University ; 2020
    In:  International Journal of Population Data Science Vol. 5, No. 5 ( 2020-12-07)
    Details
    In: International Journal of Population Data Science, Swansea University, Vol. 5, No. 5 ( 2020-12-07)
    Kurzfassung: Introduction and PurposeChronic Disease Management (CDM) plans are used by general practitioners to manage chronic diseases such as stroke. However, there is limited evidence that being on these plans improve adherence to secondary prevention medications after stroke. We aimed to assess the association of the duration on a CDM plan in improving adherence to secondary prevention medications following stroke. MethodsAustralian survivors of stroke or transient ischaemic attack were participants from the STAND FIRM trial. Patients were individually linked with claims for CDM plans from Medicare and dispensings of secondary prevention medications from the Pharmaceutical Benefits Scheme. We estimated (1) duration on a CDM plan based on the timing and Medicare items claimed and (2) the proportion of days that patients would have been covered by these medications (PDC), while accounting for deaths and instances of over-supply. Dosage for each quantity of medication was determined by the regularity in which patients returned for a refill. Logistic regression was used to evaluate factors associated with ≥80% adherence, up to 3 years after stroke, for each of antihypertensive, antithrombotic and lipid-modifying drugs. ResultsThe median PDC for 563 patients (median age 70yrs; 36% female) ranged from 92% to 95% among the three classes of medications. Approximately 27% did not take up a CDM plan, 33% were on plans for 〈 1.5 years and 40% for 1.5-3 years. Duration on a CDM plan (quintiles) was associated with adherence for antihypertensive (Odds Ratio (OR) 1.18, 95% confidence interval (95%CI) 1.00-1.40, p=0.029) and antithrombotic medications (OR 1.22, 95%CI 1.03-1.46, p=0.024), but not for lipid-lowering medications. ConclusionPeople on a CDM plan for longer had better adherence to antihypertensive and antithrombotic medications in the long-term after stroke. Use and ongoing reviews of CDM plans should be encouraged to improve adherence to secondary prevention medications after stroke.
    Materialart: Online-Ressource
    ISSN: 2399-4908
    URL: Article
    DOI: 10.23889/ijpds.v5i5.1494
    Sprache: Unbekannt
    Verlag: Swansea University
    Publikationsdatum: 2020
    ZDB Id: 2892786-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective
    SAGE Publications ; 2016
    In:  Journal of Telemedicine and Telecare Vol. 22, No. 8 ( 2016-12), p. 489-494
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 22, No. 8 ( 2016-12), p. 489-494
    Kurzfassung: 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.
    Materialart: Online-Ressource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1177/1357633X16673695
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2016
    ZDB Id: 2007700-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Establishment of an internationally agreed minimum data set for acute telestroke
    SAGE Publications ; 2021
    In:  Journal of Telemedicine and Telecare Vol. 27, No. 9 ( 2021-10), p. 582-589
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 27, No. 9 ( 2021-10), p. 582-589
    Kurzfassung: Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes. Methods An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers ( n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email. Results Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme ( n = 12), (2) details about initiating hospital ( n = 10), (3) telestroke consultation ( n = 17), (4) patient characteristics ( n = 7), (5) presentation to hospital ( n = 5), (6) general clinical care within first 24 hours ( n = 10), (7) thrombolysis treatment ( n = 10), (8) endovascular treatment ( n = 13), (9) neurosurgery treatment ( n = 8), (10) processes of care beyond 24 hours ( n = 7), (11) discharge information ( n = 5), (12) post-discharge and follow-up data ( n = 6). Discussion The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.
    Materialart: Online-Ressource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1177/1357633X19899262
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2021
    ZDB Id: 2007700-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine
    SAGE Publications ; 2020
    In:  Journal of Telemedicine and Telecare Vol. 26, No. 1-2 ( 2020-01), p. 79-91
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 26, No. 1-2 ( 2020-01), p. 79-91
    Kurzfassung: 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.
    Materialart: Online-Ressource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1177/1357633X18792380
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2020
    ZDB Id: 2007700-2
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  • 6
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    Abstract TP222: Improving the Quality of Acute Stroke Care in regional Australia: The Victorian Stroke Telemedicine Program
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Kurzfassung: Background: The Victorian Stroke Telemedicine (VST) program is the largest stroke telemedicine service operating in Australia. Patients and clinicians at 16 regional hospitals in Victoria are provided with 24/7/365 access to a network of on-call metropolitan-based neurologists via telemedicine. The VST program supports rapid differential diagnosis and enhances access to best-practice treatments for acute stroke, including transfer to comprehensive stroke centres for endovascular clot retrieval (ECR). Method: A historical-controlled cohort design was used to evaluate the VST Program. At each hospital, consecutive patient-level data were obtained 12 months before the VST program commenced (pre) and during the first 12 months of implementing the program (post). Basic clinical data were collected for patients aged 18 years or more and arriving in the Emergency Department (ED) with suspected stroke. Detailed data collection on the patient journey in hospital was conducted for patients with a confirmed ischemic stroke who arrived within 4.5 hours of symptom onset. Aggregated descriptive statistics using the available data for 16 hospitals are presented. Results: Overall, 6099 patients with suspected stroke (2932 pre, 3167 post) have presented up to 28/7/2017. Patients arriving to ED within 4.5 hours of ischemic stroke symptom onset: pre-VST n=358 (54% male; mean age 74 years) and post-VST n=484 (59% male, median age 76 years). The proportion of patients meeting these criteria who received intravenous thrombolysis increased (pre: 30% to post: 38%, p=0.019). The median door-to-needle time was faster (pre: 103 minutes; post: 72 minutes, p 〈 0.001), and more patients received thrombolysis within 60 minutes of arrival (pre: 14%; post: 32%, p 〈 0.001). Symptomatic intracerebral hemorrhage after thrombolysis was reduced (pre: 16%; post: 5%, p=0.002). Since the availability of ECR in May 2015, 25% of cases receiving thrombolysis were transferred for ECR. Conclusion: Telemedicine expedites access to optimal stroke care and immediately facilitated access to the newest intervention, ECR, with more patients safely and efficiently treated.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TP222
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Abstract P375: Using a Recalibrated Cardiovascular Disease Risk Score is Not Adequate to Predict Risk of Recurrence Within 3 Years in Australian Survivors of Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Kurzfassung: Background: Prognostic performances of models predicting risk of recurrent events of cardiovascular disease (CVD) are not adequate for use in clinical settings. We aimed to determine whether adapting the Framingham Risk Score (FRS) to an Australian population could effectively predict recurrent cardiovascular outcomes. Methods: Patients comprised survivors of stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563). We used standardised anthropometric, biochemical and blood pressure data, collected at baseline, to evaluate risk factors for stroke/TIA. Cox proportional hazards regression models were used to determine the risk of recurrence of CVD-related events and deaths within 3 years after stroke/TIA; adjudicated by two independent stroke specialists. Regression estimates were then used to recalibrate the coefficients used by the FRS, and performance of the model assessed. Results: In women, the recalibrated FRS model had poor discrimination (C-statistic = 0.634) and appeared to better predict CVD recurrence (AUC = 0.664) than the original FRS model (AUC = 0.598). However in men, the recalibrated FRS model had poor discrimination (C-statistic = 0.604) and prediction of CVD recurrence (AUC = 0.632) similar to the original FRS model (AUC = 0.606). Conclusion: The original FRS and recalibrated FRS models appeared to perform poorly in Australian men and women with stroke. The identification of relevant risk factors, easily measured in a clinical setting, may help clinicians better monitor the risks of their patients and enhance secondary prevention strategies.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.P375
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Telemedicine expedites access to optimal acute stroke care
    Elsevier BV ; 2016
    In:  The Lancet Vol. 388, No. 10046 ( 2016-08), p. 757-758
    Details
    In: The Lancet, Elsevier BV, Vol. 388, No. 10046 ( 2016-08), p. 757-758
    Materialart: Online-Ressource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(16)31360-5
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2016
    ZDB Id: 2067452-1
    ZDB Id: 3306-6
    ZDB Id: 1476593-7
    SSG: 5,21
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Telemedicine in the acute health setting: A disruptive innovation for specialists (an example from stroke)
    SAGE Publications ; 2015
    In:  Journal of Telemedicine and Telecare Vol. 21, No. 8 ( 2015-12), p. 443-448
    Details
    In: Journal of Telemedicine and Telecare, SAGE Publications, Vol. 21, No. 8 ( 2015-12), p. 443-448
    Kurzfassung: Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine. Methods Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation. Results Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and 〉 4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine. Conclusions Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine.
    Materialart: Online-Ressource
    ISSN: 1357-633X , 1758-1109
    URL: Article
    DOI: 10.1177/1357633X15610722
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2015
    ZDB Id: 2007700-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    Abstract P147: Longer Duration on a Chronic Disease Management Plan is Associated with Fewer CVD-Related Readmissions by 3 Years Among Australian Survivors of Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Kurzfassung: Background: Chronic Disease Management (CDM) plans are usually administered by general practitioners (GPs) to assist those with a chronic medical condition, such as stroke, and provide better management of risk factors. Despite the prevalent use of CDM plans, its comprehensiveness and the fact that there is a government commitment to fund it, there is limited evidence of its effectiveness in Australian survivors of stroke. We aimed to assess the effectiveness of CDM plans on preventing the recurrence of CVD-related serious adverse events. Methods: Patients comprised survivors of stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563). We used standardised anthropometric, biochemical and blood pressure data, collected at baseline, to evaluate risk factors for stroke/TIA. Poisson regression models were used to determine the incidence rate ratio (IRRs) of increasing exposure to being on a CDM plan over 3 years, while adjusting for confounding factors. We used the total count of CVD-related events and deaths within 3 years after stroke/TIA, based on either hospital discharge codes or adjudication by two independent stroke specialists. Results: Five hundred and sixty-three patients were included (median age 70; 36% female). There were 305 CVD-related events over the three years (mean 0.54), in which a third (104) were adjudicated and two-thirds (201) were derived from hospital discharge codes alone. Nearly a quarter (27%) did not take up a CDM plan over the three years, a third (33%) were on plans for less than 1.5 years and 40% were on plans from 1.5 years to 3 years. The factors most strongly associated with decreased incidence of CVD-related events were duration on a CDM plan (Adjusted IRR (aIRR) 0.85, 95% confidence interval (95%CI) 0.77-0.93; p 〈 0.001), higher level of education (aIRR 0.55, 95%CI 0.42-0.71; p 〈 0.001), more physically active occupation (aIRR 0.54, 95%CI 0.41-0.70; p 〈 0.001) and greater Assessment of Quality of Life (AQoL) score (aIRR 0.24, 95%CI 0.15-0.41; p 〈 0.001). Conclusion: Being on a CDM plan for a longer duration appeared to reduce the occurrence of CVD-related events within 3 years after stroke, potentially via more closely controlled risk factors. Patients should be encouraged to return for regular reviews of their CDM plans to enhance secondary prevention strategies, and maintain a better quality of life.
    Materialart: Online-Ressource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.P147
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2019
    ZDB Id: 1466401-X
    Standort Signatur Einschränkungen Verfügbarkeit
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