[et_pb_section bb_built=”1″][et_pb_row _builder_version=”3.0.89″][et_pb_column type=”4_4″][et_pb_post_title _builder_version=”3.0.89″ saved_tabs=”all” title=”on” meta=”off” author=”off” date=”on” categories=”on” comments=”on” featured_image=”on” featured_placement=”below” text_color=”dark” text_background=”off” \/][et_pb_text _builder_version=”3.0.89″ background_layout=”light”]<\/p>\n
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When a stroke happens, every second counts. In urban centres, victims can usually access optimal care in their area.<\/p>\n
Now, add hundreds of kilometres between the victim and treatment: for many Canadians, living in a rural area can pose a significant health risk. <\/span><\/p>\n Canadians who reside in rural areas are disadvantaged when it comes to multiple health-related measures, a 2006 report from the Canadian Institute for Health Information (CIHI) discovered. It found that rural Canadians tend to have lower socio-economic status, resulting in a higher prevalence of adverse health behaviors, such as smoking. <\/span><\/p>\n The Heart and Stroke Foundation of Canada\u2019s website states that any aspect of an unhealthy lifestyle, such as smoking, poor eating and exercise habits, obesity, and alcohol and drug abuse, contributes to the risk of stroke. It says a stroke occurs when blood stops flowing to a part of the brain, damaging brain cells and resulting in detrimental effects ranging from paralysis to death.<\/span><\/p>\n A new study conducted at Universit\u00e9 Laval has found that in-hospital mortality rates for stroke victims treated in rural hospitals is significantly higher than those treated in urban hospitals. Medical experts and the study\u2019s authors are calling for action after results showed rural patients were approximately 25 per cent more likely to die from a stroke in-hospital. <\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row][et_pb_column type=”1_3″][et_pb_text _builder_version=”3.0.89″ saved_tabs=”all” background_layout=”light”]<\/p>\n Dr. Richard Fleet, the study\u2019s lead researcher, is part of a group that works to improve research about rural hospitals and the training of rural physicians. Fleet said the main purpose of the study is to spark discussion about if Canadian health care is truly universal and to \u201cget the ball rolling in terms of advocating for more services, better services\u201d in rural health care settings.<\/span><\/p>\n Using data gathered by CIHI from 2007-2011, Fleet\u2019s team compared access to stroke diagnosis and care services across Canada, such as CT scanners and intensive care units (ICUs), in rural hospitals to those in urban hospitals.<\/span><\/p>\n The study defined rural hospitals as serving towns of 10,000 residents or less and analyzed those with 24-7 physician care and in-patient beds. Urban hospitals studied are academic centres with level one or two trauma centres which provided a wide-range of services to CT scanners, ICUs and speciality care, which Fleet called the \u201cgold standard\u201d of urban care. 286 rural hospitals met the criteria while the 24 urban hospitals that met criteria were used as a comparison point, he said.<\/span><\/p>\n Fleet said one of the main challenges was finding accurate data to adequately represent rural areas.<\/span><\/p>\n \u201cThere\u2019s very limited research in rural healthcare and rural emergency care in Canada,\u201d he said. \u201cIt\u2019s quite surprising, and so, decision-makers need some data to inform them.\u201d<\/span><\/p>\n Dr. Grant Stotts, director of the Ottawa Stroke Program, said Fleet\u2019s study is important, \u201cespecially in Canada, where a considerable portion of our population lives in rural settings.\u201d<\/span><\/p>\n \u201cThe discrepancy in stroke outcomes is important to recognize and improve,\u201d Stotts said.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”2_3″][et_pb_image _builder_version=”3.0.89″ saved_tabs=”all” src=”https:\/\/cusjc.ca\/catalyst\/wp-content\/uploads\/2018\/03\/29261956_10155949272885469_4345998813215850496_o.png” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” always_center_on_mobile=”on” force_fullwidth=”off” show_bottom_space=”on” \/][\/et_pb_column][\/et_pb_row][et_pb_row][et_pb_column type=”2_3″][et_pb_image _builder_version=”3.0.89″ saved_tabs=”all” src=”https:\/\/cusjc.ca\/catalyst\/wp-content\/uploads\/2018\/03\/29356857_10155951136600469_2043705031831584768_n.png” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” always_center_on_mobile=”on” force_fullwidth=”off” show_bottom_space=”on” \/][\/et_pb_column][et_pb_column type=”1_3″][et_pb_text _builder_version=”3.0.89″ saved_tabs=”all” background_layout=”light”]<\/p>\n According to a Heart and Stroke Foundation of Canada study published last month, 87 per cent of Canadians live within an hour\u2019s drive of stroke emergency care. Though this statistic seems promising, it varies greatly when examined province-to-province. In Newfoundland, only 45 per cent of people are within an hour\u2019s drive to stroke care. In Ontario, that figure sits at 97 per cent.<\/span><\/p>\n The Heart and Stroke study found that 69 per cent of Canadians nationwide have access to a service that operates at least five to seven days per week, and many services do not have adequate equipment to properly assess stroke victims. <\/span>Fleet\u2019s team also determined that access to CT scanners and intensive care units are critically limited in rural hospitals or missing entirely.<\/span><\/p>\n \u201cA CT scan in an emergency department for urban emergency departments is kind of a basic tool nowadays,\u201d Fleet explained. \u201cUp to 20 per cent of everyone who walks through the door of an emergency department for evaluation ends up having a CT scan.\u201d<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row][et_pb_column type=”4_4″][et_pb_text _builder_version=”3.0.89″ saved_tabs=”all” background_layout=”light”]<\/p>\n According to Heart and Stroke\u2019s website, a CT scan is used to determine the type and location of the stroke, and is vital for stroke victims to receive the correct treatment.<\/span><\/p>\n The <\/span>Canadian Stroke Best Practice Recommendations, an advisory committee funded by Heart and Stroke and the Canadian Stroke Network, advocates for better treatment of Canadian stroke victims. In 2015, the network issued a report recommending immediate CT imaging for all acute stroke victims. <\/span><\/p>\n Citing this report, Fleet\u2019s research team noted that the lack of in-hospital CT scanners in 89 per cent of rural hospitals \u201cwould hinder physicians from timely diagnosis of or administration of acute treatments when indicated.\u201d<\/span><\/p>\n Based on recommendations from international guidelines and Heart and Stroke, Fleet asserted that the ideal treatment for potential stroke victims is <\/span>to have a CT scan and have it interpreted within 30 to 45 minutes of symptoms, in order for doctors to provide quick and specific treatment. He called it concerning that this standard is often not met in rural hospitals.<\/span><\/p>\n \u201cThe first tool that should be maximized for rural settings that would assist stroke care would be 24-7 access to CT scanning,\u201d Stotts said. \u201cThis includes physical machines, as well as funding for around the clock staffing.\u201d<\/span><\/p>\n According to Fleet, many patients have reported bypassing rural health care centres and driving long distances to find stroke centres with adequate services. He said that on average, rural-dwelling Canadians are 200 kilometres from an urban emergency department or referral centre: a delay that could be fatal.<\/span><\/p>\n \u201cPatients themselves should not drive long distances with anyone suspected of a stroke,\u201d Stotts warned. \u00a0\u201cSince care is time dependent, treatment opportunities could be lost, especially if there is a misunderstanding of what is available locally and where they should go. \u00a0This information is available to paramedics.\u201d<\/span><\/p>\n Mary Wilson Trider is the President and CEO of the Almonte General Hospital in Ontario, a rural town with a population just below 5,000.<\/p>\n \u201cAlmonte General Hospital has an agreement in place which allows paramedics to bypass this hospital and go straight to a hospital in Ottawa with patients who meet the criteria for a stroke,\u201d said Trider. The drive from Almonte to Ottawa is approximately 55 minutes on the highway.<\/p>\n Access to rehabilitation services following a stroke event are also problematic in rural areas. \u201cSmall hospitals in this region generally do not have sufficient human resources to support stroke rehabilitation close to home, such as physiotherapists, occupational therapists and speech language pathologists,\u201d said Trider.<\/p>\n \u201cAll patients, regardless of whether they are urban or rural, would prefer to be cared for as close to home as possible in an environment that is familiar and close to their family and friends,\u201d said Trider. \u201cI think this is particularly true when the nature of their illness is serious and frightening, such as a stroke. It would be fantastic for the communities we serve if there were more resources available for the in-patient rehabilitation stage of their care to occur closer to home.\u201d<\/p>\n Quebec and the Territories were excluded from the study due to limitations in the CIHI data. Fleet said another limitation of the study is the difficulty in determining the exact timeline of a patient\u2019s stroke treatment. He said detailed data, such as the time at which a patient first showed symptoms, to when they were discharged from the hospital or died is not accessible.<\/span><\/p>\n \u201cIt is very complicated to obtain this information and it is quite costly,\u201d Fleet explained. \u201cIt\u2019s not readily available in databases, but that would be a really nice prospective study to discuss.\u201d<\/span><\/p>\n Going forward, efforts are being made to improve stroke treatment data. The College of Family Physicians of Canada is working with the Society of Rural Physicians of Canada and federal health minister Ginette Petitpas Taylor to develop a \u201crural road map\u201d to address rural health care issues.<\/span><\/p>\n Stotts said he would like to see improved telemedicine services and better training to local staff for stroke-specific aspects of hospital care. Telemedicine is the use of communication technology to widen access to healthcare in rural areas. <\/span><\/p>\n Through the Ontario Telemedicine Network (OTN), patients in rural areas can use apps and video calling to connect with out-of-area stroke specialists. In turn, those specialists can use the communication aids to monitor their patients. OTN has a special division called Telestroke, which connects rural physicians with stroke specialists during an emergency to ensure the best treatment plan possible is implemented.<\/span><\/p>\n \u201cInitial stroke treatment with medications can be provided locally in a rural hospital through telemedicine with a stroke physician,\u201d he explained. \u201cThis requires CT scanning capability and a telemedicine network. \u00a0This has been established in Ontario and several provinces but is not nationwide, presently.\u201d <\/span><\/p>\n Fleet added that his team\u2019s study \u201cmay just be the tip of the iceberg\u201d as to what Canadian citizens can do to \u201cadvocate, to study and to offer better standards for our rural citizens.\u201d<\/span><\/p>\n \u201cI\u2019m hopeful that things will improve, but it\u2019s going to take time,\u201d he said.<\/span><\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" [et_pb_section bb_built=”1″][et_pb_row _builder_version=”3.0.89″][et_pb_column type=”4_4″][et_pb_post_title _builder_version=”3.0.89″ saved_tabs=”all” title=”on” meta=”off” author=”off” date=”on” categories=”on” comments=”on” featured_image=”on” featured_placement=”below” text_color=”dark” text_background=”off” \/][et_pb_text _builder_version=”3.0.89″ background_layout=”light”] By Mike Barry and Naomi Librach\u00a0 [\/et_pb_text][et_pb_text _builder_version=”3.0.89″ saved_tabs=”all” background_layout=”light”] When a stroke happens, every second counts. In urban centres, victims can usually access optimal care in their area. Now, add hundreds of kilometres between the […]<\/p>\n","protected":false},"author":22,"featured_media":4010,"comment_status":"open","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"project_category":[135],"project_tag":[],"class_list":["post-3211","project","type-project","status-publish","has-post-thumbnail","hentry","project_category-feature"],"yoast_head":"\n