Member profile: Improving patient outcomes with better care models

Professor Neil Spratt is a clinical neurologist and researcher whose work aims to improve treatment and outcomes for stroke patients. He is driven by a desire to make a difference and the excitement of contributing to an area of health research that has changed so dramatically in the past 20 years.

One of the highlights of his research career has been demonstrating how improved systems of care can make as big a difference to the outcome for stroke patients as new therapies.

Stroke treatment revolutionised

Co-director of the Hunter Medical Research Institute Heart and Stroke program, which includes researchers based at John Hunter Hospital and the University of Newcastle, Professor Spratt observes that stroke has been a fantastic area to work in. “When I started out, the attitude to treatment after stroke was somewhat nihilistic. Not much could be done, and patients were left slumped in a wheelchair in the corner of a hospital ward.

“Treatment is now revolutionised and so effective that we rarely see previously common levels of severe disability.”

One innovative project he led connected EDs with stroke neurologists for rapid patient and imaging assessment, guiding critical early delivery of specialist therapies. The dramatic benefits demonstrated by the pilot helped make the case for $21 million in state and federal funding for the very successful NSW Telestroke Service to 23 rural hospitals statewide.

He is currently focused on proving the effectiveness of hybrid telehealth models for improving stroke follow-up care in rural areas.

Extending access to healthcare advances across Australia

Professor Spratt points out that “the reality of Australia’s disparate population is that in rural and remote areas, the health system can’t employ doctors with training and experience across every subspecialty.” However, he feels there is a “moral obligation” to improve the provision of care in these areas, so it isn’t substandard.

His recent telehealth pilot demonstrated how a partnership between a rural stroke coordinator and a hospital-based stroke neurologist, was highly effective at modifying care to reduce the likelihood of a secondary stroke.

The acceptability, feasibility, and effectiveness of running a rural stroke clinic in different settings is currently being funded through an Avant Grant. Support he says is particularly welcome since projects focused on improvements to systems of care and quality improvements are often harder to get funded.

Community-led telehealth builds patient trust

With this hybrid model, appointments were coordinated by local practitioners who were usually known by patients. The trust and confidence this generated is important in small country towns, particularly within local Indigenous communities.

Holding sessions at the local community health clinic with an established IT setup avoided the potential frustrations of trying to navigate video conference appointments directly with patients, and ensured patients unfamiliar with technology could access the service.

Better access for patients means better support for doctors

Professor Spratt sees technology as “an enabler we’re only in the infancy of using to improve outcomes for patients.” But he emphasises the need to be careful not to see tech on its own as the solution. “The human factor is still really important, which means we need to find imaginative solutions to attracting qualified medical professionals to rural areas.”

As well as the benefit for patients of being able to attend a specialist consultation without travelling to the nearest major hospital, he believes the evolution of telehealth-supported services has the potential to make a medical career in rural areas more appealing.

“For a GP working out of a community health centre, or registrar based in a small district hospital, knowing they are part of an established system that can connect them with experts across different disease-specific conditions, takes away the burden of having to deal with every medical situation in isolation.”

Audio-visual technology that enables paramedics and community nurses to liaise directly with a centralised support service can also reduce the need for the local doctor to be on call 24/7.

As Professor Spratt points out, hybrid telehealth models, where rural doctors and other health practitioners are trained to facilitate a consultation with the relevant specialist, also offer an important opportunity to build and develop local expertise.

This article was originally published in Connect magazine issue 22.