Abstract T P381: Implementing a Rural Stroke Prevention Clinic Using Telemedicine

Abstract

Introduction: One in eight strokes is preceded by a transient ischemic attack (Science Daily, 2009). Our primary stroke center serves a five-county area and provides support for stroke care to five rural critical access hospitals. Limited appointment availability and distance to resources were identified as obstacles preventing patients who experienced TIA’s from obtaining essential stroke-prevention work-up. Lack of appointment availability, compounded with the distance to services, resulted in week-long delays before full evaluations could be performed and interventions implemented. Using telemedicine technology, we developed a stroke prevention (TIA) clinic in a rural hospital in Washington State. Referrals for physical therapy, occupational therapy, nutritional counseling, etc. were made to departments of the rural hospital. Follow-up care was conducted in person at the neurologist's office. Patients were seen within one week of symptoms. Patients were also enthusiastic about receiving their care locally and there was a high participation rate (e.g. low no-show rate) for appointments. Hypothesis: If stroke prevention assessment services were provided at the local community level, TIA patients identified via the local emergency department would be more likely to attend the medical appointment, obtain needed assessments and receive essential stroke prevention education. Methods: The clinic was initially staffed with a neuroscience nurse practitioner who performed patient assessments and presented the patient to the attending neurologist. The neurologist participated remotely via telemedicine. The nurse practitioner and neurologist reviewed pertinent positives and developed a treatment plan in collaboration with the patient. Required testing was performed at the rural facility. Metrics, including revenue generation and patient satisfaction were gathered. Results: Patient attendance was excellent and patient satisfaction rated very high. The clinic proved to be a positive revenue generator for the hospital. Conclusions: The model has been so successful that we plan to expand the service to our other rural partner hospitals.