Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis

Background: Fast diagnosis and delivery of treatment to patients experiencing acutestroke can reduce subsequent disability. While telemedicine can improve rural commu-nity access to specialists and facilitate timely diagnosis and treatment decisions, it is notwidely used for stroke in Australia.Aim: Identifying the barriers and facilitators to clinician engagement with, and utili-sation of, telemedicine consultations could expedite implementation in rural and remotelocations.Methods: Purposive sampling was used to identify and recruit medical and nursingstaff varying in telemedicine experience across one hospital department. Twenty-fourin-depth, face-to-face interviews were conducted examining aspects surrounding stroketelemedicine uptake. Inductive qualitative thematic analysis was undertaken, and twofurther researchers veri?ed coding.Results: The main barriers identi?ed were contrasting opinions about the utility ofthrombolysis for treating acute stroke, lack of con?dence in the telemedicine system,perceived limited need for specialist advice and concerns about receiving advice from anunfamiliar doctor. Facilitators included assistance with diagnosis and treatment, theneed for a user-friendly system and access to specialists for complex cases.Conclusions: Acceptability of telemedicine for acute stroke was multifaceted and closelyaligned with regional clinician beliefs about the value of thrombolysis for stroke, high-lighting an important area for education. Addressing beliefs about treatment ef?cacy andother perceived barriers is important for establishing a stroke telemedicine programme.