title: Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis.
abstract: BACKGROUND
  Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia.
  
  
  OBJECTIVE
  Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations.
  
  
  METHODS
  Purposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding.
  
  
  RESULTS
  The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases.
  
  
  CONCLUSIONS
  Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.
authors.affiliation: Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Moloczij
authors.affiliation: National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Mosley
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
authors.forename: K M
authors.initials: KM
authors.lastname: Moss
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
authors.forename: K L
authors.initials: KL
authors.lastname: Bagot
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.|Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
authors.forename: C F
authors.initials: CF
authors.lastname: Bladin
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.|Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
authors.forename: D A
authors.initials: DA
authors.lastname: Cadilhac
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration*; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D036301:Qualitative Research; D012424:Rural Population; D012648:Self Care; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D017216:Telemedicine; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome
keywords: emergency department; remote consultation; stroke telemedicine; thrombolysis