By Darren Larsen, R.N., OHSU Stroke Center
Mike Dickinson doesn’t have to go any farther than his home office to see his OHSU neurologist and stroke nurse for checkups. The White City, Ore., resident is part of a pioneering effort to use telemedicine to deliver follow-up care to stroke patients in their homes or nearby clinics. And Dickinson appreciates being able to connect with his Portland-based medical team using his home computer instead of taking time off of work and driving to a larger community.
Indeed, it’s challenging for patients to access comprehensive stroke care in a large rural state such as Oregon, where specialized medical expertise tends to be concentrated in a handful of larger cities. Stroke patients from around the state often are transferred to Oregon Health & Science University, the only Joint Commission Certified Comprehensive Stroke Center between Seattle and San Francisco. But what happens when they leave the hospital and return home? Patients who live in rural areas don’t always have easy access to specialized stroke follow-up care. We’re trying to change that.
Stroke follow-up care has traditionally been provided in a clinic setting that requires patients to travel to larger cities. Distance, weather, jobs and other factors may make it difficult or impossible for patients to make that trip. The OHSU Telemedicine Network has been using secure two-way videoconferencing to treat strokes in the emergency departments of our collaborating hospitals for several years. Now we are using telemedicine to allow a neurologist and stroke nurse to deliver follow-up care in patients’ homes and in clinics no matter where they live. This allows stroke patients to receive the specialty care they need, while remaining in their local area.
Aggressive management of stroke risk factors such as high blood pressure and cholesterol, starting while patients are in the hospital and continuing after they leave, has been shown to reduce the chances of additional strokes. Stroke follow-up in a clinical setting has been shown to address these modifiable risk factors. Some patients can’t return to a clinic, and we don’t feel this should be a barrier to quality stroke care. We’re so convinced of the power of telemedicine to address that need that we’ve undertaken a study to compare management of stroke risk factors between patients who receive follow-up care in clinic and those who receive it in their home using a computer. And patients are enthusiastic about receiving follow-up care via telemedicine.