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Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

  • Moira K. Kapral (a1) (a2) (a3), Ruth Hall (a2) (a3), Peter Gozdyra (a2), Amy Y.X. Yu (a2) (a3) (a4), Albert Y. Jin (a5), Cally Martin (a6), Frank L. Silver (a4), Richard H. Swartz (a2) (a4), Douglas G. Manuel (a2) (a4) (a7), Jiming Fang (a2), Joan Porter (a2), Julius Koifman (a8) and Peter C. Austin (a2) (a3)...

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.

RÉSUMÉ:

L’accès aux soins de santé à la suite d’un AVC dans des communautés rurales de l’Ontario. Contexte : Des soins optimaux donnés à des patients victimes d’un AVC vont nécessiter l’accès aux ressources et aux services suivants : neuro-imagerie, revascularisation aigüe, réadaptation et prévention des AVC. Cela dit, il est possible que ces ressources et ces services ne soient pas disponibles dans certaines régions rurales. Nous avons ainsi voulu déterminer le niveau d’accès aux soins de santé prodigués à des patients victimes d’un AVC qui vivent au sein de communautés rurales de l’Ontario (Canada). Méthodes : De concert avec la base de données tirée du Fichier du réseau routier de l’Ontario, nous avons utilisé le Ontario Acute Stroke Care Resource Inventory (2016) afin d’estimer le pourcentage d’individus établis dans des communautés rurales. Pour définir de telles communautés, nous avons adopté les critères suivants : un nombre d’habitants inférieur à 10 000 ; des trajets en voiture dont les délais vont varier entre 30, 60 et 240 minutes pour atteindre des centres de soins de l’AVC (lesquels incluent des services d’imagerie cérébrale, de thrombolyse et de prise en charge des patients) ainsi que des centres de réadaptation et de traitement endovasculaire. Résultats : Sur les 1 496 262 individus établis dans des communautés rurales, la majorité d’entre eux habitent à 60 minutes ou moins en voiture d’un centre de soins doté d’équipements de tomographie par ordinateur (85 %), d’un service de thrombolyse (81 %), d’un service de prise en charge des AVC (68 %), d’une clinique de prévention des AVC (74 %), d’une unité de réadaptation pour patients hospitalisés (77 %). Cela dit, une proportion plus faible d’individus habitant à 60 minutes d’un centre de soins avait accès à des services de thrombectomie endovasculaire (32 %). Conclusions : Hormis la thrombectomie endovasculaire, la plupart des individus établis dans des communautés rurales de l’Ontario jouissent d’un accès adéquat à des centres de soins de l’AVC. Cette information pourrait s’avérer utile pour des instances gouvernementales cherchant à optimiser l’organisation régionale de soins destinés à des patients victimes d’un AVC.

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Copyright

Corresponding author

Correspondence to: Moira K. Kapral, Toronto General Hospital, 14EN 215 – 200 Elizabeth Street, Toronto, OntarioM5G 2C4, Canada. Email: moira.kapral@uhn.ca

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Keywords

Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

  • Moira K. Kapral (a1) (a2) (a3), Ruth Hall (a2) (a3), Peter Gozdyra (a2), Amy Y.X. Yu (a2) (a3) (a4), Albert Y. Jin (a5), Cally Martin (a6), Frank L. Silver (a4), Richard H. Swartz (a2) (a4), Douglas G. Manuel (a2) (a4) (a7), Jiming Fang (a2), Joan Porter (a2), Julius Koifman (a8) and Peter C. Austin (a2) (a3)...

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