Authors (including presenting author) :
Kwok WYV(1), Wong KCA(2), Chan ST(1), Fong CS(1), Yuen MKB(1), Tong WKD(3), Li WC(4), Fong WC(1)
Affiliation :
(1) MED(Stroke) Queen Elizabeth Hospital
(2) School of Nursing, The Hong Kong Polytechnic University
(3) Head Office, Hospital Authority
(4) Central Nursing Division, Queen Elizabeth Hospital
Introduction :
Stroke survivors are usually followed up in post-stroke nurse-led clinics and supported by a multidisciplinary healthcare team. Nurses in the clinic follow a structured stroke management guideline and provide comprehensive health assessments, suggest different types of rehabilitative exercises, and offer education on the prevention of recurrent stroke. During the COVID-19 pandemic, these clinic-based stroke rehabilitation services were closed due to social distancing restrictions and isolation regulations. Some stroke survivors tend to avoid social activities and prefer not to attend clinic-based follow-ups. Tele-consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing tele- consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined.
Objectives :
To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics.
Methodology :
Design: A randomized controlled trial using a hybrid effectiveness-implementation design (Type II) adopted. Both qualitative and quantitative methods will be used to evaluate the strategies for implementing the tele- consultation program, while quantitative data will be used to compare the clinical effectiveness of the tele-consultations and the usual in-person consultations.
Methods: Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials.
Result & Outcome :
As of 30 September 2023, a total of 80 stroke patients who met the inclusion criteria were recruited from the hospital. Follow-up data have been collected from 20 participants at T2 and from 10 participants at T3. However, five participants were lost to follow-up as they did not respond to the research assistant's call. It is worth mentioning that the intervention has been running smoothly without encountering any technical issues during this period.
To the best of our knowledge, this is the first study to adopt a hybrid design (Type II) to examine both the implementation and effectiveness outcomes of the adoption of telecare consultations in a post-stroke nurse-led clinic. Under the guidance of the RE-AIM framework, the Type II hybrid design not only allows the effectiveness of telecare consultations on improving health outcomes to be evaluated from the perspective of stroke survivors but also allows the implementation strategies to be evaluated from the view of stakeholders (e.g., service providers and the hospital senior management team). Evidence generated from this type of study is more valuable to policymaking as it provides broader insights from all key stakeholders and facilitates the adoption of an evidence-based program into real practice. The results of the program can guide the scaling up of the adoption of telecare consultations in other post-stroke clinics in Hong Kong, and for patients with other chronic diseases.
The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for post-stroke patients.
