Due to the nature of telehealth care, outpatient management of stroke survivors is prone to multiple barriers, however, according to new research it also offices many advantages for addressing health equity.
First author of this study, Anjail Sharrief, says that due to the COVID-19 pandemic telehealth has seen a rapid expansion into chronic care management over the past few years. She also notes that there is limited evidence for the benefits of telehealth in addressing disparities in the chronic care of patients living with stroke.
“As we begin to advance the use of telehealth in stroke and in chronic diseases in general, we must consider the potential advantages and barriers to use in populations at highest risk for disparities.
“While telehealth can expand access to care and treatment in many ways, it also has potential to increase disparities in populations with lower levels of digital literacy, limited access to internet, and in whom physical and cognitive limitations pose barriers to telehealth utilisation.”
In this study, Sharrief, along with other researchers listed the various benefits Telehealth offers for a range of stroke complications, such as impaired gait, vision and cognition, as well as for certain social departments of health, including economic instability, geographic location, and limited social support.
The example they provide refers to patients dealing with stroke-related disabilities, the researchers found that Telehealth addresses barriers related to mobility challenges and special equipment needed to access clinic spaces by removing the need for transportation all together.
It also decreases the number of in-person visits required of patients, which allows for better multidisciplinary care and the ability to remotely monitor blood pressure and cardiac arrhythmias.
Sharrief, says: “One important thing to consider is that while we focus on stroke-related disability, the same principles apply to patients with other neurological diseases.”
The research team also identified key barriers stroke survivors face when it comes to telehealth, including physical disabilities from stroke, cognitive disabilities from stroke limited access to internet, limited digital literacy, and limited language proficiency, and outlined potential strategies to address them.
The researchers listed their key recommendations for accommodating stroke survivors with limited internet access and digital literacy include:
- Utilise social workers or community health workers to connect patients to available federal programs, such as the Affordable Connectivity Program, which offers discounts for internet access as well as discounts toward the purchase of a laptop, desktop computer, or tablet.
- Provide mobile hotspot devices to patients with limited Wi-Fi access.
- Use community-based telehealth outposts for visits.
- Use cellular devices for telemonitoring (e.g., blood pressure monitoring), instead of services or devices requiring Bluetooth.
- Use texting, secure messaging, smart phone applications, and other tools that do not require high-speed internet.
- Develop digital tools to accommodate patients with impaired literacy or cognitive limitations.
- Provide digital literacy training as a component of interventions.
- Use digital health navigators.
- Include patients with impaired digital literacy in intervention or study design.
Sharrief, says: “Several of the listed recommendation have shown promise for improving telehealth access and utilisation in other chronic disease populations.
“My group and co-authors on the manuscript are testing these in the stroke population.”
The researchers also gave recommendations on accommodating patients with hemiparesis or incoordination resulting from stroke. They suggest developing telehealth tools and engaging informal caregivers and family members to participate in telehealth interventions.
For stroke survivors with cognitive issues, they suggest avoiding the use of some tools, such as platforms and monitoring equipment, that require multiple steps for setup or need regular troubleshooting.
Futhermore, for stroke patients with limited language proficiency, the authors encourage the development of telehealth platforms, telemonitoring tools, and other digital health tools to accommodate patient and caregiver language preferences.
