Telehealth Trials to Address Health Equity in Stroke Survivors

Abstract

Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.

Health Equity and Actionable Disparities in Stroke: 2022 Update

“…Sarfo et al make a case for both the efficacy and cost-effectiveness of polypill interventions for cardiovascular disease prevention; however, highlight the importance of using implementation science to determine barriers to systematic implementation of such interventions. The reviews by Reeves et al, 2 Sharrief et al 3 , and Sarfo et al highlight several of the considerations in Kapral’s 1 framework for the future of research addressing stroke inequities. Specifically, in all interventions discussed—care transitions, telehealth, and polypills—social determinants of health need to be addressed or considered to reduce inequities.…”

“…Reeves et al 2 provide insight into the existing evidence evaluating care transition interventions to improve outcomes and reduce inequities in stroke. Sharrief et al 3 summarize the rationale for using telehealth interventions in stroke to reduce inequities and provides practical advice on how to address barriers to telehealth interventions for historically disenfranchised populations. Sarfo et al make a case for both the efficacy and cost-effectiveness of polypill interventions for cardiovascular disease prevention; however, highlight the importance of using implementation science to determine barriers to systematic implementation of such interventions.…”

“…Reeves et al 2 provide insight into the existing evidence evaluating care transition interventions to improve outcomes and reduce inequities in stroke. Sharrief et al 3 summarize the rationale for using telehealth interventions in stroke to reduce inequities and provides practical advice on how to address barriers to telehealth interventions for…”

“…Sharrief et al 3 provide insight into potential telehealth applications to reduce stroke inequities. 3 Telehealth has been used for acute stroke treatment for decades.…”

“…Sharrief et al 3 provide insight into potential telehealth applications to reduce stroke inequities. 3 Telehealth has been used for acute stroke treatment for decades. Although it has expanded access to acute stroke care for those with poor access, it remains unclear whether telestroke has reduced racial and ethnic and sex inequities in acute stroke care.…”