Integrating acute stroke telemedicine consultations into specialists\u2019 usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

On Behalf Of The Vst And Astute Investigators ,Kathleen L Bagot,Caroline L Watkins,Catherine E Lightbody,Alison S R Mcloughlin,Christopher I Price,Michelle Vu,Carl R May,Elaine Day,Gary A Ford,Dominique A Cadilhac,Christopher F Bladin,D Paul Davies,Geoffrey A Donnan,Josephine M E Gibson,Hedley C A Emsley,Helen M Dewey

doi:10.1186/s12913-017-2694-1

Abstract

BackgroundStroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations.MethodsSpecialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70.ResultsCross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures.ConclusionAustralian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.

Highlights

Stroke telemedicine can reduce healthcare inequities by increasing access to specialists
Telemedicine can increase access to hyper-acute stroke care in places where there are a limited number of stroke specialists, including rural areas
The final sample for analysis consisted of six interviews from five Australian specialists and five interviews from five United Kingdom (UK) specialists; a total of N = 10 specialists

Summary

Introduction

Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. We compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Evaluation results show telemedicine for acute stroke is safe (i.e. no significant difference in post-treatment intracerebral haemorrhage or mortality rates), reliable and valid (i.e. similar patient assessment, including stroke severity) and cost effective (i.e., from hospital and social perspectives) [1, 3]. Exploration of barriers and enablers to implementation have generally focused on organizational factors (e.g. licensing, credentialing, reimbursement and malpractice liability) [4, 5], and which models to use [6] Whilst these studies provide insights into organisational practices and policies, there are few well-designed process evaluations to provide insights into how telemedicine is embedded and integrated into practice [7]

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Results

Discussion

Conclusion