Women, trust your gut if you suspect a stroke; how to judge

Stroke is the fourth-most common cause of death in women, and rural women are particularly in danger because stroke victims must get treatment quickly to improve their odds of a good outcome, and that can be harder to find in rural areas, Madelyn Ostendorf reports for Successful Farming. 

When women have a stroke, they're more likely than men to experience sudden confusion as an initial symptom. Here are some other common symptoms:

• sudden loss of limb control
• loss of vision
• difficulty speaking
• drooping of one side of the face

Less common but still important signs to watch for are:

• difficulty reading
• double vision
• trouble balancing
• tingling in the limbs

To assess whether someone, including oneself, is having a stroke, remember the acronym FAST:

• F: Face drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person's smile uneven?
• A: Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S: Speech difficulty. Is speech slurred?
• T: Time to call 911.

Rural hospitals need telehealth most but often don't have it

Rural hospitals are the most likely to benefit from telemedicine, especially for emergency patients, but they're the least likely to have it because of government reimbursement barriers and low patient volume, according to a study report in the Journal of the American Medical Association.

The researchers used telestroke care as a case study. Stroke patients must receive treatment very quickly, and often there is not enough time to transfer them to a larger hospital that has stroke specialists. Through telestroke, small, rural hospitals can initiate care for such patients, but they are less likely to have telehealth than larger, suburban hospitals, and the inequity may contribute to worse conditions and more deaths among rural patients.

The cost of implementing telehealth is a significant barrier for rural hospitals; it can cost from $17,000 to $50,000. Plus, hospitals must pay an average of $60,000 for annual subscription fees, and $3,000 to $8,000 per year in maintenance and connectivity expenses. And many such hospitals don't get enough patients who need telehealth to cover the costs of the service. And dealing with the reimbursements—which are often insufficient—is a bureaucratic headache many hospitals would rather avoid. 

The researchers suggest some changes that could help increase telehealth adoption in rural emergency departments. For instance, EDs pay for telemedicine, but the reimbursement typically goes to the remote specialist who treats the patient via telehealth. EDs can bill consultants for the hospital's telehealth subscription expenses, but it's such a cumbersome process that most EDs just eat the cost and write it off as overhead. Instead, the paper suggests, payers could reimburse the hospital directly for telehealth-related costs.

Study: the more rural a place is, the higher the incidence of stroke risk factors, especially smoking among the poor

It's well-known that rural residents are at a higher risk of stroke. But a newly published study in The Journal of Rural Health examined the trend across rurality and found that, the more rural the place, the higher the prevalence of stroke risk factors such as hypertension, diabetes, heart disease, smoking, poverty, and more. Most interestingly, the study uncovered a link between stroke incidence and higher smoking rates, especially in poorer areas. 

Previous research has found that more rural areas have higher stroke mortality rates than more densely populated areas, but that's mainly because of a higher stroke incidence, not a higher case fatality, the authors write.

That said, health-care access disparities also worsen rural stroke survival rates, a 2020 study found. Small, rural hospitals often can't quickly transfer stroke patients to bigger hospitals with access to more experienced specialists and newer treatments, according to the study. 

Study: rural neurologist shortage means less-specialized care for many patients; expanded telehealth could help

"A shortage of neurologists in rural parts of the United States means that people in those areas are less likely to receive specialized care for conditions such as stroke, dementia and back pain," Robert Preidt reports for HealthDay. That's according to a newly published study in the journal Neurology.

University of Michigan researchers reviewed one year of Medicare data and identified 2.1 million patients who visited a doctor for a neurological condition at least once during that time. Availability of neurologists ranged from a low of 10 for every 100,000 people to a high of 43 for every 100,000 people, Preidt reports.

"Overall, 24 percent of patients with a neurologic condition were seen by a neurologist, but rates varied from 21% in more rural areas to 27% in more urban areas with the most neurologists. Most of that difference involved patients with dementia, back pain and stroke," Preidt reports. "Among dementia patients, 38% of those in more rural areas saw a neurologist, compared to 47% in more urban areas. The rates for stroke patients were 21% and 31%, respectively." More than 80% of Parkinson's disease patients received care from a neurologist no matter where they lived, and the rate was similar for multiple sclerosis patients.

The study underlines the need to expand access to neurologists in rural areas, possibly through telehealth, said James Stevens, president of the American Academy of Neurology.