Abstract
Stroke is a leading cause of death and disability, and recombinant tissue plasminogen activator (rtPA) can significantly reduce the long-term impact of acute ischemic stroke (AIS) if given within 3 h of symptom onset. South Carolina is located in the “stroke belt” and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. We used a retrospective cross-sectional design examining Census data from 2000 and geographic information systems analysis to identify South Carolina residents that live within 30 or 60 min of a primary stroke center (PSC) or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a PSC or a REACH MUSC hospital within 30 or 60 min. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within 60 min given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within 60 min of expert stroke care, and 43% of the population to be within 30 min drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can greatly increase access to care for residents throughout South Carolina.
Highlights
Stroke is a leading cause of death and disability in the United States (Thom et al, 2006; Hoody et al, 2008)
MATERIALS AND METHODS We studied U.S Census data for South Carolina from the year 2000 to estimate the number of individuals who have access to stroke center care via a primary stroke center (PSC) or through REACH MUSC
We examined the breakdown of South Carolinians within 30 or 60 min of a PSC or REACH MUSC hospital as it relates to individual age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality in the county where the individuals lived
Summary
Stroke is a leading cause of death and disability in the United States (Thom et al, 2006; Hoody et al, 2008). South Carolina has especially high stroke incidence and mortality rates, in younger and African American patients when compared to the rest of the country. South Carolina has ranked among the highest in the country for stroke mortality (Lackland et al, 1998; Shrira et al, 2008). In 1996, the Food and Drug Administration (FDA) approved the use of recombinant tissue plasminogen activator (rtPA), a fibrinolytic drug, for the treatment of acute ischemic stroke (AIS; O’Fallon et al, 2004). RtPA was the first FDA approved treatment for AIS, the use of rtPA has not become widespread in part because it must be administered within 3 h of the onset of stroke symptoms (Kleindorfer et al, 2004; Hacke et al, 2008; Meschia, 2009). Capampangan et al (2009) report that despite over a decade after FDA approval still fewer than 5% of AIS patients receive rtPA
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