By Susanna Zuurbier & Peter Vanacker*, NeuroVascular Center Antwerp, Antwerp University Hospital, Belgium
Tomorrow’s care starts today
Over the past few weeks, we have all dealt with the consequences of the COVID-19 pandemic. It is inspiring and heartwarming to see how healthcare professionals are meeting these new challenges. Unlike many European countries, stroke care in Belgium is not centralized and there are unique challenges that require new solutions; we hope the changes we have made to outpatient stroke care are relevant to others in Europe and beyond.
To avoid bringing patients to the hospital, we do all routine follow-up visits by teleconsultation. Patients with acute or rapidly-progressing neurology are still seen in the hospital and are urgently treated, but those with transient or mild symptoms are managed via teleconsultation. In Belgium we have experience with mobile health (mHealth) projects: on behalf of the Belgian Stroke Council (BSC), a nurse-led self-management program was developed, using a personal coach and digital platform with the aim of improving cardiovascular risk factor control in patients after ischemic stroke.(1) The stroke coach provides one educational session during hospitalization. After discharge, the stroke coach delivers a series of video appointments that focus on healthy lifestyle measures to reduce vascular risk. The program was implemented in four Belgian hospitals for a pilot study (2017-2018) (1). Later, several other hospitals joined, creating a strong community of stroke coaches. This network prepared us for the consequences of COVID-19 on outpatient care. Although the national government created a legal framework in 2017 for mHealth reimbursement, no structural reimbursement could be achieved. The current COVID-19 pandemic reopened the discussion and for the first time, the national health authorities accepted reimbursement of video-consultations by doctors.
Furthermore, the number of closed outpatient rehabilitation facilities is dramatic; many stroke survivors are at risk of readmission to the hospital due to the lack of ambulatory rehabilitation. One solution to this problem might be to integrate mHealth programs in the daily neurorehabilitation routine. We previously assessed the potential of online neurorehabilitation under supervision of a physiotherapist and/or speech therapist; these early experiences serve as a platform for rapid implementation, and are endorsed by neurology clinical guidelines.
The COVID-19 pandemic also has serious personal and social effects. We wish those whose relatives or loved ones are ill much strength and a speedy recovery. Take care.
* Chair Scientific Board Belgian Stroke Council
(1) Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke. Kamoen O, Maqueda V, Yperzeele L, Pottel H, Cras P, Vanhooren G, Vanacker P. Acta Neurol Belg. 2020 Feb;120(1):91-97. doi: 10.1007/s13760-019-01218-z. Epub 2019 Nov 7.