Addressing inequity in acute stroke care requires attention to each component of regional workflow

Watson, Tayler; Tiu, Jeigh; Clissold, Ben

doi:10.5694/mja2.50440

Topics

A multifaceted approach will enable equitable stroke care for regional communities

About 56 000 strokes occur in Australia annually1 at an estimated economic cost of $5 billion per year.2 Inequity continues to separate regional and metropolitan populations with respect to incidence and management of acute ischaemic stroke. Risk factors for acute ischaemic stroke disproportionately burden regional Australia and this is reflected in the high rate of strokes in regional compared with metropolitan areas (250 v 210 per 100 000 population per year respectively).1 Of the 12 electorates with highest stroke incidence nationally, nine are in regional areas.1

1 Monash Health, Melbourne, VIC
2 Goulburn Valley Base Hospital, Shepparton, VIC
3 Barwon Health, Geelong, VIC

Correspondence: tayler.watson@monashhealth.org

Competing interests:

No relevant disclosures.

1. Deloitte Access Economics. No postcode untouched report: stroke in Australia 2017. Melbourne: National Stroke Foundation, 2017. https://strokefoundation.org.au/What-we-do/Research/No-postcode-untouched (viewed Nov 2019).
2. Deloitte Access Economics. The economic impact of stroke in Australia: Scoping cost effective prevention. Melbourne: National Stroke Foundation, 2013. https://www2.deloitte.com/au/en/pages/economics/articles/economic-impact-stroke-australia.html (viewed Nov 2019).
3. National Stroke Foundation. National stroke audit: acute services report. Melbourne: National Stroke Foundation, 2017. https://informme.org.au/-/media/7D1480925C2046BA914F3F66D392B83A.ashx?la (viewed Nov 2019).
4. Bray JE, Johnson R, Trobbiani K, et al. Australian public's awareness of stroke warning signs improves after national multimedia campaigns. Stroke 2013; 44: 3540–3543.
5. Ambulance Victoria. Ambulance Victoria performance — 2017/18 quarter 4. Melbourne: Ambulance Victoria, 2018. https://www.ambulance.vic.gov.au/wp-content/uploads/2018/07/2017-18-Q4-Ambulance-Response-Quarter-4-FY2017-18.pdf (viewed Nov 2019).
6. Walter S, Zhao H, Easton D, et al. Air‐Mobile Stroke Unit for access to stroke treatment in rural regions. Int J Stroke 2018; 13: 568–575.
7. Leyden JM, Chong WK, Kleinig T, et al. A population‐based study of thrombolysis for acute stroke in South Australia. Med J Aust 2011; 194: 111–115. https://www.mja.com.au/journal/2011/194/3/population-based-study-thrombolysis-acute-stroke-south-australia
8. Regenhardt RW, Mecca AP, Flavin SA, et al. Delays in the air or ground transfer of patients for endovascular thrombectomy. Stroke 2018; 49: 1419–1425.
9. Silbergleit R, Scott PA, Lowell MJ, Silbergleit R. Cost‐effectiveness of helicopter transport of stroke patients for thrombolysis. Acad Emerg Med 2003; 10: 966–972.
10. O'Brien W, Crimmins D, Donaldson W, et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre‐hospital notification system for expedient management of acute stroke. J Clin Neurosci 2012; 19: 241–245.
11. Meretoja A, Weir L, Ugalde M, et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology 2013; 81: 1071–1076.
12. Wardlaw JM, Seymour J, Cairns J, et al. Immediate computed tomography scanning of acute stroke is cost‐effective and improves quality of life. Stroke 2004; 35: 2477–2483.
13. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2014; (7): CD000213.
14. Kepplinger J, Barlinn K, Deckert S, et al. Safety and efficacy of thrombolysis in telestroke: a systematic review and meta‐analysis. Neurology 2016; 87: 1344–1351.
15. Switzer J, Demaerschalk B, Xie J, Fan L, Villa K, Wu E. Cost‐effectiveness of hub‐and‐spoke telestroke networks for the management of acute ischemic stroke (P05.243). Neurology 2012; 78(Suppl): P05.243.
16. Bagot KL, Bladin CF, Vu M, et al. Exploring the benefits of a stroke telemedicine programme: an organisational and societal perspective. J Telemed Telecare 2016; 22: 489–494.
17. Moffatt JJ, Eley DS. The reported benefits of telehealth for rural Australians. Aust Health Rev 2010; 34: 276–281.
18. Australian Institute of Health and Welfare. Australia's health 2016 [Australia's health series No. 15; Cat. No. AUS 199]. Canberra: AIHW, 2016. https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787-AH16.pdf.aspx (viewed Nov 2019).

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