AcuteCare Telemedicine Blog

Now is the Time

Like any other year, the beginning of 2013 brings a great deal of optimism about what surprising changes and exciting opportunities and a new year will bring, not just to healthcare, but to our everyday lives. We are living in an age of constant innovation and untamed enthusiasm for what is new. Every day, we read news about the pioneering of new solutions for age-old problems and find ourselves astonished by what we can accomplish with the collective knowledge of generations past and a zeal for moving towards the future.

Telemedicine is a prime example of an entire industry fueled by this fervor for innovation, and the resulting advances it has brought to the way we think about healthcare are nothing short of remarkable. Unfortunately, the level of investment in terms of initial costs and putting trust in new technologies has been enough of an obstacle to prevent many facilities to postpone the adoption of telemedicine.

Embracing telemedicine is about far more than flashy new technology and the promise of saving costs; it is about taking steps forward to make our world a better place. For example, the latest tragedy to make national news out of Newtown, CT served as a stark reminder that there are still great strides that need to be made in order to address the needs of individuals with psychiatric conditions. Fortunately, through telepsychiatry programs and the drastic improvements in patient monitoring capabilities afforded by telemedicine, it is easier than ever before to get help. Extending the attention and the care that is so desperately needed in cases such as these will undoubtedly help us prevent many such worst-case scenarios.

It is the hope of AcuteCare Telemedicine and other proponents of telehealth that the plethora of new equipment and methods available to providers will continue to propel healthcare towards an era in which every individual has unhindered access to the care they need. There has never been a more important time to push the many benefits of telemedicine into the spotlight, and take the first steps towards achieving this goal.

Collaboration Across the Pond

Relations between the US and the UK are particularly amiable, arguably at an all time high, and moving towards modernity, our cultures have engaged in a ‘give and take’ from one another. However, when it comes to discussion of healthcare policy, our politicians and citizens are often quick to dismiss one another’s perspectives.

Despite the huge disparities in approach, each country’s current desires in regards to changing their healthcare situation are fairly equivalent. Both nations are working towards getting better value from healthcare expenditures, encouraging providers to focus on quality with better incentives, and controlling rising health care costs, regardless of the differences in who is paying.

Telemedicine offers both systems huge advantages in the pursuit of these goals, and the two can learn from one another. In the US, telemedicine has helped curb unnecessary and irresponsible healthcare spending, an important consideration for a nation currently obsessed with combating rising costs detrimental to its economy. Abroad, electronic patient care records are managed efficiently, falling in line with the expectations of the unified, government-controlled National Health Service (NHS) responsible for administrating healthcare.

It is important to keep in mind the great differences in context between the implementation of telemedicine in the United Kingdom and here at home. Of course, the NHS provides citizens with what we have dubbed as “Universal” health care, which is free to the patient at the point of service. In contrast to the Brits’ centrally governed and tax-funded system, care in the US is available through a multitude of competitive providers and is paid for by a patchwork of public and private insurers. The fact of the matter is, telemedicine works as a solution to a myriad of challenges, and both countries are discovering new solutions every day.

Healthcare officials in both countries envision telemedicine playing prominent roles in the future of their respective systems. Perhaps in the short term, this vision will be a common ground on which to open a mutually beneficial dialogue to address the unique challenges facing each nation.

Obstructive Sleep Apnea and Atherosclerosis

Atherosclerosis is the leading cause of stroke and cardiovascular disease, the leading causes of death internationally, but recently, obstructive sleep apnea (OSA) has also been found to be an independent risk factor for stroke. One explanation may lie in the propensity towards the development of atherosclerosis in this disorder. Identifying this and other potential risk factors of atherosclerosis and understanding how these risk factors behave independently and comorbidly will hopefully reduce the risk of atherosclerotic disease, ultimately aiding in the prevention of stroke.

OSA is a lesser known independent risk factor for stroke than hypertension (HTN), but both are frequently observed as comorbidities in patients with cardiovascular disease and stroke. In 2009, a study published in Hypertension found that patients with OSA and patients with HTN had an increase in carotid wall thickness compared to controls by 19.4% and 19.5% respectively. In patients with OSA and HTN, the increase was found to be 40.3% in carotid wall thickness over controls. These and other findings strongly suggest that OSA is indeed an independent risk factor for the development of carotid atherosclerosis.

OSA has been shown to independently increase several markers of atherosclerosis including sympathetic activity, pro inflammatory factors and endothelial dysfunction. In addition, OSA can lead to other atherosclerotic risk factors such as alteration in lipid metabolism, insulin resistance and hypertension.  In 2007, a separate study published in the American Journal of Respiratory and Critical Care Medicine involved twenty-four patients with OSA and without comorbidities. After 4 months of treatment with continuous positive airway pressure, there was a reduction in markers of inflammation and sympathetic activation as well as a decrease of carotid wall thickness; again evidence to suggest OSA as a risk factor for atherosclerosis.

The importance of these studies and others suggesting OSA as an independent risk factor for atherosclerosis is to arm physicians with more ways to combat the incidence of stroke and cardiovascular disease. Because of the high incidence of OSA in patients with HTN, control of HTN alone may not adequately reduce atherosclerotic risk. Screening tools such as the STOP/BANG and Berlin questionnaire should be utilized in  hypertensive patients, particularly those with refractory disease (>3 BP meds with adequate control or 3 BP meds with inadequate control). Overnight polysomnography should be performed in patients identified at risk for OSA and treatment should be initiated when appropriate. Likewise, in patients without known atherosclerotic risk factors but suspected OSA, screening and diagnostic studies should be performed. These measures can help to further reduce the incidence of atherosclerosis and subsequently reduce the incidence of cardiovascular disease and stroke.

What Stroke and Heart Attack Have In Common

Because brains and hearts are highly dependent on oxygen-rich blood to survive, current guidelines from the American Heart Association call for treatment in under an hour for both strokes and heart attacks. The phrase “Door-to-treatment” refers to the time it takes from a patient’s emergency room arrival to the initiation of treatment.

In heart attacks, “door-to-balloon” more specifically refers to the use of an angioplasty balloon to relieve a constricted or obstructed blood vessel. In cases of stroke, the key phrase is, “door-to-needle,” referring to the administration of the intravenous medication tPA. The two different organs, with different vascular beds and dealt with by different teams of specialists within a hospital, remain subject to very similar constraints in time and quality measures.

The care of these patients requires a team approach with emergency room nurses and doctors rapidly initiating the process. At all hours, parallel specialized teams must stand ready to reverse critical brain and heart ischemia. Telemedicine technologies have proven to be an efficient solution in allowing very rapid access to quality care.

As leaders in the fight against the morbidity and mortality of these emergencies, AcuteCare Telemedicine (ACT) leads the stroke team at several hospitals, ensuring that proper treatment is available to patients within the critical hour. In addition, ACT monitors stroke care and provides important feedback to the hospitals it serves, because constant evaluation of the timeliness and quality of treatment is a crucial component in reducing the “door to needle” time to help save lives.