Telemed J E Health - State primary stroke center policies in the United States: rural health issues.

Tópicos

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Resumo

JECTIVE: To explore the relationship between state primary stroke center (PSC) designation policy implementation and access to optimal stroke care for residents of rural areas.MATERIALS AND METHODS: Primary data were collected during the period September 2008-August 2009. Following content analysis of state PSC policies, four case study states were selected for fieldwork, in part for state rural healthcare access challenges. Variables included the barriers and facilitators to PSC designation policy implementation. More than 100 semistructured stakeholder interviews were conducted by teams of researchers. Large-group meetings were also observed. Interview summaries were reviewed by stakeholders for accuracy and completeness.RESULTS: The consistent finding in all study states was that PSC designation and state policy implementation in rural areas are unlikely for a variety of reasons, including lack of financial resources for telemedicine, difficulty maintaining neurology coverage, and emergency departments unable to administer thrombolytics. Findings indicate recognition by states about the need for stroke-care public policy specific to telemedicine in rural areas.CONCLUSIONS: Although state PSC designation policies raise awareness of rural issues, designation policy alone cannot overcome the obstacle of rural access to optimal stroke care. States must be technology-ready, and providers need to embrace e-health and telemedicine to ensure coordination of care for stroke victims in rural areas. More important is that state policy makers should provide rules and regulations to encourage PSC hospitals to use telemedicine and "proxy credentialing" to support their affiliated rural facilities.

Resumo Limpo

jectiv explor relationship state primari stroke center psc design polici implement access optim stroke care resid rural areasmateri method primari data collect period septemb august follow content analysi state psc polici four case studi state select fieldwork part state rural healthcar access challeng variabl includ barrier facilit psc design polici implement semistructur stakehold interview conduct team research largegroup meet also observ interview summari review stakehold accuraci completenessresult consist find studi state psc design state polici implement rural area unlik varieti reason includ lack financi resourc telemedicin difficulti maintain neurolog coverag emerg depart unabl administ thrombolyt find indic recognit state need strokecar public polici specif telemedicin rural areasconclus although state psc design polici rais awar rural issu design polici alon overcom obstacl rural access optim stroke care state must technologyreadi provid need embrac ehealth telemedicin ensur coordin care stroke victim rural area import state polici maker provid rule regul encourag psc hospit use telemedicin proxi credenti support affili rural facil

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