Telestroke in stroke survivors.
Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices.
Joubert
Jacques
J
Division of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia. jacquesjoubert@bigpond.com
Joubert
Lynette B
LB
de Bustos
Elizabeth Medeiros
EM
Ware
Dallas
D
Jackson
David
D
Harrison
Terrence
T
Cadilhac
Dominique
D
D000328:Adult; D017028:Caregivers; D006801:Humans; D010821:Physicians, Family; D055502:Secondary Prevention; D020521:Stroke / Q000191:economics / Q000628:therapy*; D000071939:Stroke Rehabilitation; D017741:Survivors; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data*