Moira K Kapral1,2,3, Ruth Hall2,3, Peter Gozdyra2, Amy Y X Yu2,3,4, Albert Y Jin5, Cally Martin6, Frank L Silver4, Richard H Swartz2,4, Douglas G Manuel2,4,7, Jiming Fang2, Joan Porter2, Julius Koifman8, Peter C Austin2,3. 1. Department of Medicine, Division of General Internal Medicine, University of Toronto, Canada. 2. ICES, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. 4. Department of Medicine, Division of Neurology, University of Toronto, Canada. 5. Department of Medicine (Neurology), Queen's University, Canada. 6. Kingston Health Sciences Centre, Canada. 7. Ottawa Hospital Research Institute, Canada. 8. Department of Medicine, Division of General Internal Medicine, William Osler Health System, Canada.
Abstract
BACKGROUND: Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada. METHODS: We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers. RESULTS: Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT). CONCLUSIONS: Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
BACKGROUND: Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada. METHODS: We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers. RESULTS: Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT). CONCLUSIONS: Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
Authors: Ana Barragán-Prieto; Soledad Pérez-Sánchez; Francisco Moniche; Roberto Valverde Moyano; Fernando Delgado; Patricia Martínez-Sánchez; Miguel Moya; Juan M Oropesa; Adolfo Mínguez-Castellanos; Inmaculada Villegas; María José Álvarez Soria; Jose Antonio Tamayo Toledo; Carlos de la Cruz Cosme; Rafael Canto Neguillo; Juan Manuel Herrerías Esteban; Daniel José Montero Cobos; Jose Antonio Moreno Muñoz; Alejandro González; Joan Montaner Journal: Eur Stroke J Date: 2022-05-25