Saturday, November 22, 2014

Can India deliver comprehensive stroke care?

In my previous articles, I talked about the extent to which stroke affects the people in India and how it is important for the country as a whole to take steps towards fighting this epidemic. One of the questions that often comes up during the discussion is how to overcome the high cost of infrastructure, manpower and the lack of awareness among the people. In the coming articles, I discuss the strategies that will help in establishing cost-effective comprehensive healthcare in general and stroke in particular.


Few countries in the world have experienced the explosive growth of internet usage that India is going through. India took more than ten years to grow from 10 million to 100 million internet users, three years to grow from 100 to 200 million; however, only a year to grow from 200 to 300 million users. According to a recent report 'Internet in India 2014', that is jointly published by the Internet and Mobile Association of India (IAMAI) and IMRB International, the number of internet users in India would reach 302 million by December 2014, registering a growth of 32 per cent over last year and surpassing the United States to become the country! It is also interesting to note that whereas the internet usage in urban India has grown by 29% in one year, that in rural India has grown by 39%. The primary use of internet in urban India is for search, online communication and social networking whereas that in rural areas is primarily entertainment followed by communication and social networking.

It will be, but foolish to not reap the benefits of telecommunication in healthcare and, India stands at a distinct advantage among the developing countries in this regard. Using telecommunications to connect stroke experts to the physicians and patients in rural areas dramatically improves the quality of care. With telestroke, patients in rural hospitals can have round-the-clock access to stroke specialists in specialized stroke centers. With telestroke, stroke specialists can clinically examine the patients in a remote hospital hundreds of kilometers away, view the CT and MRI scans and assist the physicians directly taking care of the patient in decision making. If the patient requires to be transferred to the specialized center, the transfer process can be expedited, thus cutting down the time to recanalization.

In Bavaria, Germany, telestroke units were introduced in 12 regional hospitals lacking neurology and neurosurgery departments. These 12 regional hospitals were linked to two stroke centers with 24 x 7 availability of vascular neurologists and neurosurgeons. Between 2003 and 2012, the percentage of patients with stroke treated at these hospitals increased from 19% to 78%. It also helped to provide immediate neurosurgical consultation in patients with hemorrhagic stroke. With the help of good internet and telecommunications, many district level and rural hospitals can be linked to the specialist stroke centers and patients cared for immediately at presentation. This will dramatically reduce the delay between the onset of symptoms and treatment. If tPA is to be administered, the medication can be administered and then the patient transported to a higher center. Another interesting finding from the German telestroke study was that the percentage of patients that actually were transferred to the specialized stroke center decreased over the ten years. The reason was that more and more patients were being treated at the peripheral hospitals and only those that genuinely required advanced care were treated at the referral center.

Low-cost strategies such as the use of video conferencing, smart phone apps that relay information to healthcare workers and assist the emergency medical services personnel to treat patients while being transferred to the hospital are very helpful and hospital systems should incorporate them while developing protocols for stroke care. Effective and innovative use of telecommunication systems is paramount to effective management of stroke in India.

1 comment:

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