A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue

BMC Health Services Research

Lars Thomassen³  Rolf Salvesen¹  Ellen Rygh⁴  Kari Dyb²  Tove Sørensen² 

[1] University of Tromsø, Tromsø, 9038, Norway;Norwegian Centre for Integrated Care and Telemedicine, Tromsø, NO-9038, Norway;Haukeland University Hospital, Bergen, NO-5021, Norway;Norwegian Centre for Integrated Care and Telemedicine, Kirkeveien 9, Kolbjørnsvik, NO-4816, Norway

关键词: Collaboration;    Acute stroke;    Norway;    Overview;    Qualitative;    Technology;    Telestroke;   

Others  :  1089981
DOI  :  10.1186/s12913-014-0643-9

 received in 2014-04-10, accepted in 2014-12-09,  发布年份 2014

【 摘 要 】

Background

To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates.

In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today’s status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice.

Methods

This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for ‘telestroke in Norway’ was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved.

Results

In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience.

The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space).

Conclusions

Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis.

【 授权许可】

   
2014 Sørensen et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Elford RD: Telemedicine in northern Norway. J Telemed Telecare 1997, 3(1):1-22.
• [2]Gammon D, Bergvik S, Bergmo T, Pedersen S: Videoconferencing in psychiatry: A survey of use in northern Norway. J Telemed Telecare 1996, 2:192.
• [3]Johnsen E, Breivik E, Myrvang R, Olsen F: Gevinster av norsk telemedisin. 2006.
• [4]More health for each bIT. Oslo: Ministry of Health; 1996, https://www.regjeringen.no/nb/dokumenter/mer-helse-for-hver-bit/id87401/?regj_oss=10.
• [5]Saver J: Time is brain - quantified. Stroke 2006, 37:263-6.
• [6]Audebert H: Telestroke: effective networking. Lancet Neurol 2006, 5(3):279-82.
• [7]LaMonte M, Bahouth M, Hu P: Pathan Mea. Telemedicine for acute Stroke. Stroke 2003, 34:725.
• [8]Deshpande A, Khoja S, McKibbon A, Rizo C, Jadad AR: Telehealth for acute stroke management (Telestroke): Systematic Review and Environmental Scan [Technology overview 37]. Ottawa, Canada, Canadian Agency for Drugs and Technologies in Health; 2008.
• [9]Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA, Levine SR, Mayberg M, Meyer BC, Meyers PM, Skalabrin E, Wechsler LR: A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2009, 40:2616-2634.
• [10]Müller-Barna P, Schwamm LH, Haberl RL: Review. Telestroke increases use of acute stroke therapy. Curr Opin Neurol 2012, 25:5-10.
• [11]Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH: The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke 2012, 43(8):2078-85. Epub 2012/06/16
• [12]Khan K, Shuaib A, Whittaker T, Saqqur M, Jeerakathil T, Butcher K, Crumley P: Telestroke in Northern Alberta: a two year experience with remote hospitals. Can J Neurol Sci 2010, 37(6):808-13. Epub 2010/11/10
• [13]French B, Day E, Watkins C, McLoughlin A, Fitzgerald J, Leathley M, Davies P, Emsley H, Ford G, Jenkinson D, May C, O’Donnell M, Price C, Sutton C, Lightbody C: The challenges of implementing a telestroke network: a systematic review and case study. BMC Med Inform Decis Mak 2013, 13(1):125. BioMed Central Full Text
• [14]Sairanen T, Soinila S, Nikkanen M, Rantanen K, Mustanoja S, Färkkilä M, Pieninkeroinen I, Numminen H, Baumann P, Valpas J, Kuha T, Kaste M, Tatlisumak T: Finnish Telestroke Task Force: Two years of Finnish Telestroke: thrombolysis at spokes equal to that of the hub. Neurology. 2011, 29(76):1145-1152.
• [15]National guidelines for treatment and rehabilitation for ischemic stroke Norwegian Directorate of Health 2010, IS-1688, http://www.helsedirektoratet.no/publikasjoner/nasjonal-retningslinje-for-behandling-og-rehabilitering-ved-hjerneslag-fullversjon/Sider/default.aspx.
• [16]Quality indicators for the health service. Oslo: Norwegian Directorate of Health; 2013 [cited 2014 20 January]; Available from: http://helsenorge.no/Helsetjenester/Sider/Kvalitetsindikatorer-rapporter.aspx?kiid=Trombolysebehandling_ved_hjerneinfarkt.
• [17]Zanaboni P, Knarvik U, Wootton R: Adoption of routrine telemedicine in Norway: the current picture. Global Health Action 2014, 7:22801.
• [18]Mosby. Mosby's Medical Dictionary. Mosby's Medical Dictionary. 8 ed2009. Elsevier. ISBN 978-0-323-05290-0.
• [19]Bolle S, Larsen F, Hagen O, Gilbert M: Video conferencing versus telephone calls for team work across hospitals: a qualitative study on simulated emergencies. BMC Emerg Med 2009, 9(1):22. BioMed Central Full Text
• [20]Audebert HJ, Schenkel J, Heuschmann P, Bogdahn U, Haberl RL: Effects of the implementation of a telemedical stroke network: the Telematic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 2006, 5:742-748.
• [21]Guerrero W, Savitz S: Tissue-type plasminogen activator for stroke mimics. Continuing to be swift rather than delaying treatment to be sure. Stroke 2013, 44:1213-1214.
• [22]Authority WNRH. Treatment and rehabilitation of ischemic stroke in Western Norway Regional Health Authority. Bergen, Norway: 2012. http://www.helse-vest.no/aktuelt/rapporter/Documents/Regionale%20planar/Regional%20plan%20-%202012-06%20Behandling%20og%20rehabilitering%20ved%20hjerneslag.pdf.
• [23]Salvesen R, Eldøen G: Treatment of cerebral infarction at the stroke unit in Bodø 2011–12. Tidsskr Nor Laegeforening 2013, 133:1824-1826.
• [24]Chau P, Hu P: Investigating health care professionals’ decisions to accept telemedicine technology: an empirical test of competing theories. Inform Manage 2002, 39:297-311.
• [25]Walter Z, Lopez M: Physician acceptance of information technologies: Role of perceived threat to professional autonomy. Decision Support Systems 2008, 46:206-215.
• [26]Demaerschalk BM: Telemedicine or telephone consultation in patients with acute stroke. Curr Neurol Neurosci Rep 2011, 11(1):42-51.