Authors (including presenting author) :
Kwok WYV(1), YuenMK(1), Chan ST(1), Fong CS(1)
Affiliation :
(1)Department of Medicine, Queen Elizabeth Hospital
Introduction :
Available evidence supports the value of secondary preventive services delivered by nurses in post-acute stroke clinics in improving the functional ability of stroke survivors and reducing their re-admission rates. Nurse-led post-acute stroke clinics had been developed to provide services to stroke survivors in Queen Elizabeth Hospital since 2016. However, the policy of reducing hospital visits during the current COVID-19 pandemic had limited the access of stroke survivors to such services. Since “telehealth consultations” has been shown to be an alternative potential method to provide public access to healthcare services, a telehealth post-acute Stroke clinic has been set up in Queen Elizabeth hospital since 2020 April. Both types of nurse-led clinics had been delivered by experience specialty advanced practice nurses.
Objectives :
To compare the effectiveness of post-acute stroke clinics delivered via traditional mode of face-to-face consultations in the earlier phase with the telehealth consultations since its establishment.
Methodology :
This is a retrospective analysis to compare the outcomes of the participants who received the two different modes of consultations. The outcome parameters included unplanned readmission(s), recurrent stroke(s) and mortality within 3 months from their initial stroke episode. The data was collected in hospital and outpatient notes, as well as from Electronic Patient Record (ePR) if necessary.
Result & Outcome :
Three hundred seventy-five cases had attended face-to-face post-acute Stroke nurse clinics from Oct 2016 to December 2019, while 234 cases had attended the telehealth clinic from April to October 2022. There were 24 unplanned readmissions (6.4%) in those who received face-to-case consultations, while there were 16 unplanned readmissions (6.8%) in the telehealth consultation group (P=0.505). On the other hand, there were no recurrent strokes or mortality within 3 months in both group.
Conclusions: A substantial number of post-stroke patients had received post-stroke assessment services in a telehealth mode within the relatively short period since its establishment. The outcome parameters revealed no statistical significance in terms of the 3 vital stroke outcome parameters, implying the inferiority effectiveness of the telehealth mode of delivery. The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, although how it can be applied in nurse-led clinics has not been reported. Which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.
Discussions: Apart from providing a viable solution to those post-acute stroke patients who cannot or are unwilling to endure the travel inconvenience or long waiting time, which would be welcoming to both patients and their carers, this small retrospective study had also provided support for its non-inferior effectiveness when compared to the traditional face-to-face consultations. This would lend support to its continued value even after the COVID-19 pandemic in running such nurse clinics. Future prospective comparisons would be useful to further establish its value and the optimal range of services that it can provide.
