The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina.

OBJECTIVE: To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS: Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS: Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS: Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.

Testing the Effectiveness of a Community-Based Peer Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Zimbabwe.

OBJECTIVES: Social isolation and stigma contribute to poor mental health outcomes. Adolescent mothers in Zimbabwe often experience isolation and stigma, lacking social support and resources to navigate motherhood. The study tested the effectiveness of a community-based peer support intervention to mitigate social isolation and stigma of adolescent motherhood in Harare, Zimbabwe. METHODS: Community health workers (n = 12) and peer educators (n = 12) in the intervention arm were recruited and trained on co-facilitating peer support groups. Adolescent mothers aged 15-18 years from two low-income high-density communities in Harare were recruited, using a quasi-experimental design. The intervention arm (n = 104) participated in the peer support groups and both arms completed sociodemographic, base-, mid-, and end-line surveys (control arm n = 79). Peer support groups (12 groups with 6-12 participants in each) met in-person twice a month and completed 12 sessions from May to August 2019 addressing participant-identified topics such as income generation and depression. WhatsApp Messenger was used for training and implementation support. Key community stakeholders discussed project progress and recommendations to improve adolescent mothers' health. Data were analyzed using Stata 15. RESULTS: The intervention arm reported lower depressive symptoms and common mental disorders and higher overall, family, friends, and significant-other support, compared to control. The intervention arm felt more engaged with peers, knew who and where to turn to for help, and had coping, parenting and communication strategies to manage life challenges. CONCLUSIONS FOR PRACTICE: The intervention mitigated social isolation and stigma and thereby improved mental health and social support among adolescent mothers in Harare. Trial Registration This trial is registered at Clinical Trials.gov, NCT05213182 https://clinicaltrials.gov/ct2/show/NCT05213182 .

What is already known on this subject? Social isolation and stigma contribute to poor mental health outcomes. Adolescent mothers often experience isolation and stigma, lacking social support and resources to navigate motherhood. There is a need for interventions that identify and address the unique needs of adolescent mothers.What this study adds? A community-based peer-support intervention can mitigate social isolation and stigma and thereby improve mental health and social support of adolescent mothers. WhatsApp Messenger is a potential intervention tool for providing training and implementation support, and enhancing communication between peer support group facilitators and participants.

Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011-2021.

Background: The use of telehealth for the management and treatment of hypertension and cardiovascular disease (CVD) has increased across the United States (U.S.), especially during the COVID-19 pandemic. Telehealth has the potential to reduce barriers to accessing health care and improve clinical outcomes. However, implementation, outcomes, and health equity implications related to these strategies are not well understood. The purpose of this review was to identify how telehealth is being used by U.S. health care professionals and health systems to manage hypertension and CVD and to describe the impact these telehealth strategies have on hypertension and CVD outcomes, with a special focus on social determinants of health and health disparities. Methods: This study comprised a narrative review of the literature and meta-analyses. The meta-analyses included articles with intervention and control groups to examine the impact of telehealth interventions on changes to select patient outcomes, including systolic and diastolic blood pressure. A total of 38 U.S.-based interventions were included in the narrative review, with 14 yielding data eligible for the meta-analyses. Results: The telehealth interventions reviewed were used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach. These interventions utilized the expertise of physicians, nurses, pharmacists, and other health care professionals to collaborate on patient decisions and provide direct care. Among the 38 interventions reviewed, 26 interventions utilized remote patient monitoring (RPM) devices mostly for blood pressure monitoring. Half the interventions used a combination of strategies (e.g., videoconferencing and RPM). Patients using telehealth saw significant improvements in clinical outcomes such as blood pressure control, which were comparable to patients receiving in-person care. In contrast, the outcomes related to hospitalizations were mixed. There were also significant decreases in all-cause mortality when compared to usual care. No study explicitly focused on addressing social determinants of health or health disparities through telehealth for hypertension or CVD. Conclusions: Telehealth appears to be comparable to traditional in-person care for managing blood pressure and CVD and may be seen as a complement to existing care options for some patients. Telehealth can also support team-based care delivery and may benefit patients and health care professionals by increasing opportunities for communication, engagement, and monitoring outside a clinical setting.