By Anthony J. Brown, MD
An internet-based network that allows doctors in rural hospitals to consult a stroke expert in real-time can hasten the delivery of clot-busting drugs to treat stroke patients, new research indicates.
With the network, known as REACH, doctors at eight rural hospitals in Georgia were able to immediately consult a stroke expert at the Medical College of Georgia (MCG). The system, which incorporates a video feed, allows the consultant to examine the patient and view the CT scan and then decide if treatment with tissue plasminogen activator (tPA) is needed.
A previous report has shown that stroke care at rural hospitals often does not follow published guidelines and that tPA is used infrequently.
Lead author Dr. David C. Hess, from the Augusta-based MCG, told Reuters Health that "doctors at rural centers may not feel comfortable reading a CT scan for stroke and may be worried about giving tPA, which carries a 6 percent rate of intracranial hemorrhage." The REACH system "is a way of providing physicians at rural hospitals with immediate access to a stroke consultant at any time."
In the new study, reported in the medical journal Stroke, the researchers describe the results of 194 stroke consultations that were delivered with REACH. Thirty of the patients received tPA.
The average and median National Institutes of Health Stroke Scores were 15.4 and 12.5, respectively.
The time between stroke onset and treatment fell during the study period from 143 minutes for the first 10 patients to 111 minutes for last 20 patients. Sixty percent of patients received tPA within two hours and 23 percent received it within 90 minutes.
None of the patients treated with tPA experienced symptoms of cerebral hemorrhage, the report indicates.
"We were surprised by the findings -- we never thought we'd be treating patients with tPA in under 2 hours or, in some cases, 90 minutes," Hess said. "Rural hospitals move pretty fast in getting blood work and CT scans done, they just need assistance in interpreting the results and making treatment decisions."
Hess said that the REACH system could probably be applied to a number of rural settings across the US. However, he noted that the biggest obstacle to widespread adoption of this and similar telemedicine systems is reimbursement.
He explained that Medicare and insurance companies have certain reimbursement stipulations that, at present, do not encourage the adoption of such systems.
SOURCE: Stroke, September 2005.
Copyright 2005 Reuters Limited.
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