Impact of an outpatient telestroke clinic on management of rural stroke patients

Objective: Report on feasibility, use and effects on investigations and treatment of a neurologist-supported stroke clinic in rural Australia. Design: Data were collected prospectively for consecutive patients referred to atelehealth stroke clinic from November 2018 to August 2021. Settings, participants and interventions: Patients attended the local hospital, with a rural stroke care coordinator, and were assessed by stroke neurologist over videoconference. Main outcome measures: The following feasibility outcomes on the first appointments were analysed: (1) utility (a) change in medication, (b) request of additional investigations, (c) enrolment/offering clinical trials or d) other; (2) acceptability (attendance rate); and (3) process of care (waiting time to first appointment, distance travelled). Results: During the study period, 173 appointments were made; 125 (73.5%) were first appointments. The median age was 70 [63-79] years, and 69 patients were male. A diagnosis of stroke or transient ischemic attack was made by the neurologist in 106 patients. A change in diagnosis was made in 23 (18.4%) patients. Of the first appointments, 102 (81.6%) resulted in at least one intervention: medication was changed in 67 (53.6%) patients, additional investigations requested in 72 (57.6%), 15 patients (12%) were referred to a clinical trial, and other interventions were made in 23 patients. The overall attendance rate of booked appointments was high. The median waiting time and distance travelled (round-trip) for a first appointment were 38 [24-53] days and 60.8 [25.6-76.6] km respectively. Conclusion: The telestroke clinic was very well attended, and it led to high volume of interventions in rural stroke patients.