Modelling accessibility of adult neurology care in Australia, 2020–2034

Simpson‐Yap, Steve; Frascoli, Federico; Harrison, Lucinda; Malpas, Charles B; Burrell, James R.; Child, Nicholas; Giles, Lauren P; Lueck, Christian J.; Needham, Merrilee; Tsang, Benjamin; Kalinčík, Tomáš

doi:10.1136/bmjno-2023-000407

Cited by 3 publications

(2 citation statements)

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“…This shortage is exacerbated by high rates of burnout among early career neurologists [14], increasing complexity of neurotherapeutics, and general and family physicians (practitioners) feeling less confident in managing neurological diseases. Ongoing (or expected) decrease in the neurological workforce including fewer general neurologists (GNs) in high‐income countries. Australia expects a significant shortfall of workforce relative to the projected demand between 2020 and 2034 [15]. In the USA, the number of American Academy of Neurology (AAN) members who self‐identify as GNs has fallen from 46% in 2014 to 28% in 2023 (Table 1).…”

Section: Introductionmentioning

confidence: 99%

General neurology: Current challenges and future implications

Bassetti,

Accorroni,

Arnesen

et al. 2024

Euro J of Neurology

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Background and purposeIn the coming decades, the world will face an increasing burden of neurological disorders (ND) and an urgent need to promote brain health. These challenges contrast with an insufficient neurological workforce in most countries, as well as decreasing numbers of general neurologists and neurologists attracted to work in general neurology (GN). This white paper aims to review the current situation of GN and reflect on its future.MethodsThe European Academy of Neurology (EAN) task force (TF) met nine times between November 2021 and June 2023. During the 2023 EAN annual meeting, attendees were asked to answer five questions concerning the future of GN. The document was sent for suggestions and eventually approval to the board and the presidents of the 47 national societies of the EAN.ResultsThe TF first identified four relevant current and future challenges related to GN: (i) definition, (ii) practice, (iii) education, and (iv) research. The TF then identified seven initiatives to further develop GN at both the academic and community level. Finally, the TF formulated 16 recommendations to promote GN in the future.ConclusionsGN will remain essential in the coming decades to provide rapid, accessible, and comprehensive management of patients with ND that is affordable and cost‐effective. There is also a need for research, education, and other initiatives aiming to facilitate improved working conditions, recognition, and prestige for those pursuing a career in GN.

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Section: Introductionmentioning

confidence: 99%

General neurology: Current challenges and future implications

Bassetti,

Accorroni,

Arnesen

et al. 2024

Euro J of Neurology

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“…Australia is a large country with low population density in rural regions and long distances between comprehensive stroke centers, making timely access to acute stroke therapies across all locations challenging. Approximately 30% of the Australian population lives outside of metropolitan areas (AIHW, 2023), while only 4% of the neurology workforce provide services within these regions and this shortfall is predicted to persist into the future (Simpson-Yap et al, 2023). Compounding this issue, there is a 17% higher risk of stroke in regional and rural Australia (Stroke Foundation, 2020).…”

Section: Introductionmentioning

confidence: 99%

Rollout of a statewide Australian telestroke network including virtual reality training is associated with improved hyperacute stroke workflow metrics and thrombolysis rate

Garcia-Esperon,

Maltby,

Butcher

et al. 2024

Front. Stroke

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BackgroundTelestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.AimsThe overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.MethodsThis study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.ResultsA total of 2,683 patients were included (April 2013–December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56–118] to 54 min [40–76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68–114] vs. 68.5 min [54–90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3–31 sessions per site).ConclusionsDelivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

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