Telestroke was associated with a significant increase in thrombolysis rate and reduction in door-to-needle time in provincial hospitals indicating improved patient care. Quantification of the extra neurologist workload allowed for a seamless transition to 'business as usual' using a novel annual subscription funding and service model.

Minimising the use of medical terminology in medical correspondence significantly improved patient understanding and perception of their ability to manage their chronic health condition. Although there was no impact on EQ-5D depression/anxiety scores, overwhelming patient preference for the 'translated' letter indicates a need for minimisation of medical terminology in medical correspondence for patients with chronic health conditions.

Introduction: Telestroke can improve access to experts at smaller hospitals to assist with thrombolysis decision making. We trialled a regional telestroke ‘hub’ and ‘spoke’ model that was associated with a substantial increase in thrombolysis rates at ‘spoke’ hospitals. One ‘spoke’ hospital, however, elected to discontinue the telestroke service and returned to providing thrombolysis solely under the guidance of local general physicians. The rationale being that the transient telestroke service helped to upskill local doctors and that the boost in rate was partially or even mainly due to other changes in the local services. Methods: This is a sequential comparison of three periods: 6 months pre-telestroke, 6-months during telestroke, and 6-months post telestroke. Main outcomes were thrombolysis rate and door-to-needle time with versus without telestroke support. Results: Over the 18-month period, 25 patients of 195 admitted ischemic stroke patients were thrombolyzed at this small centre. The thromboloysis rate was 8.5% (6/71) during the 6-months pre, 23.0% (14/61) during the 6-months of, and 7.9% (5/63) during the 6-months post the use of telestroke support from the tertiary centre (with telestroke odds (95% CI) of being thrombolyzed 3.33 (1.41-7.86); p=0.006). Patients receiving thrombolysis within 60 minutes of arrival were 50% before, 64% during, and 20% after telestroke (with telestroke OR (95%CI) 3.15 (0.61-16.3); p=0.16). Careful review of patients not treated after discontinuation of telestroke revealed that nine additional patients would have likely been treated had a stroke specialist been involved in the decision-making process raising treatment rate to 22% (14/63). Conclusion: These finding indicate that the transient implementation of telestroke was insufficient to upskill provincial hospital generalist clinicians to sustain a high thrombolysis rate. It also supports the conclusion that telestroke itself contributed strongly to the increase in treatment rate rather than the rate increase being primarily attributable to other factors. The numbers are small and need to be interpreted with caution. However, interestingly, the rates at centres who have opted to continue with telestroke have been maintained at the much higher level.

Purpose:The latent risk of developing acute/chronic forms of heart disease among older Australians remains at historical highs despite significant advances in pharmacotherapy and devices to treat the condition.Methods: Data from a contemporary study on the burden of chronic heart failure (CHF) in Australia (population ∼24 million and ∼25% live in regional settings) were used to calculate the number of de novo CHF admissions (n=27,468) per annum. From these, we estimated the proportion of HFcases readmitted (37.3%), days of HF-related hospitalisation (1,006,113 days from 147,347 admissions) and case-fatality (30.5%) within 12 months. Health economic data from a recent multicentre trial of CHF management were then applied to estimate the direct cost burden imposed by HF.Results: The greatest burden of HF lies in hospital stays (de novo/recurrent) among individuals >65 years (281,647 days men versus 306,332 days women). Total healthcare expenditure (including in-patient care and associated community management costs) for managing HF is estimated at $2.68 billion/annum ($1.46 billion men versus $1.22 billion women). The direct cost of in-patient care (non-elective) imposed by HF remains high and contributed to around two thirds (68% or $1.82 billion) of the total expenditure; whilst the estimated annual cost of managing HF in the community was just under $900 million ($573 million men versus $294 million women).Conclusions: Taking into account the increasing longevity of Australians, these figures are likely to rise without the application of evidence-based strategies capable of cost-effectively reducing the costliest component of HF management -hospital stay.http://dx. Aim:To determine whether minimising the use of Latin medical terminology in medical correspondence improved patient understanding and anxiety/depression scores.Background: There is little existing research on the role that secondary care letters have in ensuring patient understanding of chronic health conditions.Methods: A single-centre, non-blinded, randomised crossover design assessed health literacy, EQ-5D scores, and the impact of the 'translated' letter on the doctor's professionalism, the patient's relationship with their GP, and their perceived impact on chronic disease management. Patients were crossed over between their 'translated' and original letter. Ethics approval granted by Northern B Health and Disability Ethics Committee. UTN: U111-1160-8460.Results: 60 patients were recruited. There was no effect on EQ-5D depression/anxiety scores (z=-0.378, p=.705). Use of a 'translated' letter reduced median terms not understood from five to zero (z=5.367, p<0.0005). Most patients (77.6%) preferred the 'translated' letter, with 69% patients perceiving an enhancement in their doctor's professionalism (p<0.0001, 95%CI:0.5645-0.7926), 68.3% reporting a positive influence on relationship with their GP (p<0.0001, 95%CI: 0.5573-0.7867), and 79.4% reporting an increase in perceived ability to manage their chronic health condition with the 'translated' let...

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