THE ROLE OF TELEMEDICINE
TECHNOLOGY IN THE CARE OF STROKE PATIENTS
Williem Alexander Hartanto
Universitas Udayana, Bali, Indonesia
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KEYWORDS |
ABSTRACT |
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Technology;
Telemedicine; Stroke |
Technological
advances in the health sector are one of the factors in meeting optimal
health, especially in places that provide health services. The use of
technology in helping health services is one of the uses of telemedicine
technology in treating stroke patients. This writing aims to discover the
role of telemedicine technology in the care of stroke patients. The research
method used in this study is descriptive-analytical. The study was conducted
to analyze selected literature from various
sources, which will later become a new idea related to the role of
telemedicine technology in the care of stroke patients. The results of this
study show that Telemedicine is considered very important for handling and
providing therapy to patients, which is undoubtedly supported by the correct
diagnosis. Telemedicine with health interventions through the capabilities of
information technology, either smartphones or other wireless networks,
extensively provides benefits and opportunities for the world of health to have
a good influence in improving the quality of life of patients with stroke. |
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DOI: 10.58860/ijsh.v2i10.112 |
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Corresponding Author: Williem Alexander Hartanto
Email: Williemusalexander@gmail.com
INTRODUCTION
Health is essential and desired by every human being because health is a
state of physical, mental, and social well-being that allows every person to
live a productive life socially and economically. Health must be viewed as an
investment to improve the quality of human resources. Health is one of the main
components in measuring the Human Development Index.
The health need is the main thing (Manurung,
2021). There are still many
health problems in Indonesia, including non-communicable diseases requiring
long-term treatment (Kausar,
2019). The disease that many
Indonesian people suffer from is stroke. Stroke is a condition that occurs when
the blood supply to the brain is disrupted due to a blockage (ischemic stroke)
or rupture of a blood vessel (hemorrhagic stroke).
This condition causes parts of the body controlled by the damaged area of the brain
not to function correctly (Nurfallah,
2021). This disease causes
disability in the form of paralysis of the limbs, speech disorders, and thought
processes due to impaired brain function.
Stroke or CVD is a sudden neurological deficit in the central nervous
system caused by ischemic or hemorrhagic events with
a multi-complex etiology and pathogenesis (Fitriani
& Mulyono, 2022). One of the causes of
stroke is high blood pressure. The higher the blood pressure, the greater the
amount of vascular damage, which can trigger blood vessels to burst (Nurfallah,
2021). According to the World
Health Organization (WHO), in 2018, stroke was one of the leading health
problems in the world. Stroke is the third leading cause of death.
The incidence of stroke is not yet known with certainty. However, several
journals state that a poorly treated stroke can worsen the patient's condition (Magda
et al., 2023). Realizing that health
services are a need for every citizen, the government occasionally strives to
produce programs that can improve health services as a whole, including by
utilizing existing technology (Ma'mur
& Ahmad, nd).
Therefore, a breakthrough is needed to overcome strokes, which often
occur today. Technology is essential to help speed up the healing and treatment
of patients, especially strokes. One thing nurses give
to patients and the development of information technology in the field of
nursing that is widely applied is Telemedicine.
Along with increasingly advanced developments in science and technology,
Telemedicine is emerging as an innovation in health services. Telemedicine as
part of telehealth is an essential component of the
future of health services (Andrianto
& Fajrina, 2021). Telemedicine expands
access to health services for patients in urban and rural areas. Telemedicine
has many clinical benefits, including remote monitoring and offering telehealth services to residents.
However, with the many benefits of Telemedicine, there are also many
limitations. The most significant limitations are economic, regulatory, and
technical issues. Telemedicine is one of the most essential strategies to
reduce the pandemic's increasing rate by implementing social distancing (Ahmad
et al., 2021). This is where
Telemedicine plays a role in helping and supporting the healthcare system,
especially in public health, prevention, and clinical practice. Significant
advances in Telemedicine are designed to help address this pandemic and
demonstrate how the emergence of Telemedicine can transform the preparedness
infrastructure of healthcare systems. Currently, the main effort in
Telemedicine is in diagnosing and monitoring physiological dysfunction.
This study aimed to assess the effectiveness of telemedicine technology
in the treatment of stroke patients. This includes evaluating the extent to
which telemedicine can assist in early diagnosis, treatment, and monitoring of
patients, as well as their impact on clinical outcomes.
METHOD
The research
method used in this research is analytical descriptive with the type of data
used in the form of secondary data obtained from literature studies, in the
form of materials from journals, magazines, websites, books, etc. Connected to
the phenomena that occur. The data collection tool
used in this research is a document study. The data analysis method used is a
qualitative data analysis method. The study was conducted to analyze literature selected from various sources, which
will later become a new idea related to the role of telemedicine technology in
the care of stroke patients.
RESULTS AND DISCUSSION
Stroke or CVD
Stroke or CVD is a sudden neurological
deficit in the central nervous system caused by ischemic or hemorrhagic
events with a multi-complex etiology and
pathogenesis. Stroke is the leading cause of physical or mental disability in
old age and productive age. With its characteristics, stroke is a severe
problem worldwide (Fitriani &
Mulyono, 2022).
According to the Minister of Health Nila F. Moeloek (January 6,
2016), stroke and traffic accidents were the biggest causes of death 2015.
Meanwhile, infectious diseases such as tuberculosis were ranked sixth, preceded
by ischemic heart disease, cancer, and diabetes mellitus (Muhammad Wali et al .,
2023). Stroke is the second cause of death and
the third cause of disability worldwide. According to WHO, stroke is a
condition where rapidly developing clinical signs are found in focal and global
neurological deficits, which can be severe and last for 24 hours or more,
causing death (Mahmudah, 2014). Strokes that result in paralysis and
require further treatment, which, of course, requires quite a long time and
quite a lot of money (Kausar, 2019).
In 2019, stroke was ranked first among the
ten causes of death and disability in Indonesia, sourced from healthdata.org (Li & He, 2022), and the highest risk factor for death and
disability was caused by high blood pressure (Li & He, 2022). Stroke severity is the main predictor of
health utility value (Du et al., 2018). Many complications can affect daily
living activities in stroke sufferers, and this can increase death rates. So,
implementation is needed to improve the quality of life, including reducing
depression rates (Widiyanto et al.,
2022). Stroke is the main trigger for long-term
disability. The high rate of disability due to stroke is caused by disruption
of cerebral tissue, resulting in the inability to carry out daily activities,
mental and emotional disorders, and decreased productivity (Fitriani &
Mulyono, 2022).
Stroke is a neurological function disorder
caused by disruption of blood flow to the brain, which can arise suddenly or
quickly with symptoms or signs that correspond to the brain's disturbed area.
Stroke sufferers require long-term treatment, and medical costs are very high;
the problem of decreased patient productivity compounds this. Stroke is a
neurological emergency, with mortality and morbidity increasing yearly (Lisiswanti & Putra,
2016).
Stroke is Korea's third leading cause of
death after cancer and heart disease. It has become the leading cause of death
in developed countries such as the United States and Europe. Two-thirds of
patients survive, but most have severe disabilities, requiring comprehensive
rehabilitation therapy to recover from neurological damage and loss of
function. Stroke is a leading cause of long-term disability; only a quarter of
patients recover sufficiently to lead independent lives.
Therefore, stroke is a disease that
requires severe treatment, and preventive measures are needed for society
because of the severe economic and social impacts caused by this disease. The
public health burden of stroke is expected to increase over the coming decades
due to the demographic transition of populations, especially in developing
countries (Donkor, 2018).
The clinical symptoms of stroke depend on
the area of the brain where blood flow is disturbed and the function of the
brain area where blood flow is disturbed. Clinical manifestations, in general,
are paralysis on one side of the body, impaired feeling on one side of the
body, disturbed speech or not being able to speak or not understanding speech,
swallowing disorders, slanted mouth, balance problems, visual disturbances to
decreased consciousness, then post-stroke can occur, including epilepsy,
dementia or forgetfulness, and depression. The incidence of stroke is that one
person suffers a stroke every minute, and almost 20 people die every hour.
The clinical picture of stroke includes:
1. Infarction of the central
nervous system Signs and symptoms of arterial infarction depends on the
vascular area affected:
1) Total infarction of the
anterior (carotid) circulation: hemiplegia (damage to the upper part of the corticospinal tract), hemianopia (damage to the optic
radiation). Cortical deficits include dysphasia (dominant hemisphere) and loss
of visuospatial function (non-dominant hemisphere).
2) Partial infarction of anterior
circulation: hemiplegia and hemianopia, cortical deficit only.
3) Lacunar infarction: intrinsic
disease (lipo hyalinosis)
of the small deep arteries causes a characteristic syndrome.
4) Posterior (vertebrobasilar)
circulation infarction: signs of brainstem lesion, homonymous hemianopsia. e. Spinal cord infarction.
2. Transient ischemic attack (TIA
= transient ischemic attack) A typical sign of TIA is a sudden loss of focal
CNS function; symptoms such as syncope, confusion, and dizziness are
insufficient to establish a diagnosis. TIA generally lasts only a few minutes,
rarely lasting hours.
3. Hemorrhagic subarachnoid hemorrhage (SAH) Due to irritation of the meninges by
blood, the patient shows symptoms of sudden (within seconds) very severe
headache accompanied by photophobia, nausea, vomiting, and signs of meningismus (stiff neck and dry signs). In heavier
bleeding, intracranial increase and disturbance of consciousness can occur. On fundoscopy, papilledema and retinal hemorrhage
can be seen. Focal neurological signs may occur due to the false localization
effect of increased intracranial pressure, concomitant intracerebral
hemorrhage, and spasms of blood vessels due to the
irritant effect of blood together with ischemia.
4. Spontaneous intracerebral
hemorrhage Patients present with focal neurological
signs depending on the location of the hemorrhage,
seizures, and features of increased intracranial pressure. The diagnosis is
usually apparent from a CT scan.
Thus, to prevent these aspects from
worsening, all acute stroke sufferers must be monitored continuously for their
general condition, brain function, ECG, oxygen saturation, blood pressure, and
body temperature for 24 hours after the stroke.
The Role of Telemedicine
Technology in Stroke Patient Care
The term Telemedicine comes from the words
"Tele," a Greek word meaning "distance," and
"modern," is a Latin word meaning "to heal." Although
initially considered "futuristic" and "experimental,"
Telemedicine has become a reality. It is being implemented in various parts of
the world. Telemedicine has various application aspects, namely, providing
health services to patients, educational purposes, research, administration,
and public health (Andrianto &
Fajrina, 2021). The World Health Organization (WHO)
states that the term Telemedicine‖ was first coined in 1970, which means
distance healing. WHO defines Telemedicine as The delivery of health care
services, where distance is a critical factor, by all health care professionals
using information and communication technologies for the exchange of valid
information for diagnosis, treatment, and prevention of disease and injuries,
research and evaluation, and for the continuing education of health care
providers, all in the interests of advancing the health of individuals and
their communities (Andrianto, 2021).
Thus, Telemedicine is the delivery of
health care services, where distance is a critical factor, by all health care
professionals using information and communication technologies to exchange
valid information for diagnosis, treatment, and prevention of disease and
injury, research and evaluation, and education. Sustainable.
Healthcare providers, all in the interest of advancing the
health of their individuals and communities. The application of
Telemedicine in Indonesia is new. In 2016, telemedicine applications emerged
and began to develop. Then, the COVID-19 pandemic, which entered Indonesia in
March 2020, increased public interest and the need for health services via
Telemedicine (Andrianto &
Fajrina, 2021). Telemedicine is a feasible and safe
method for providing health services (Batubara et al., 2021). One of the main components of
neurosurgical telemedicine services that differs from Telemedicine in general
is the importance of evaluating and diagnosing disease, especially for new
patients and cases of suspected stroke (Moazzami et al., 2020).
Terms such as Telemedicine are used
interchangeably to refer to services using electronic technology for patients
over distance limitations. In its application, telehealth
is beneficial in fulfilling health welfare for patients and families (Utama et al., 2023). Telemedicine is a long-distance health
service through the use of communication and information technology that can
provide health service solutions for remote areas where health facilities are
inadequate (Ariyanti &
Kautsarina, 2017). With Telemedicine, health workers can
find out directly about the client's clinical condition without having to meet
face to face so that they can provide appropriate interventions or health
services that suit the client's condition (Manurung, 2021). The application of Telemedicine in
Indonesia is new. In 2016, telemedicine applications emerged and began to
develop. Then, the COVID-19 pandemic, which entered Indonesia in March 2020,
was one of the factors in the increase in public interest and need for health
services via Telemedicine. Telemedicine is an alternative for providing health
services that minimize direct contact between doctors and patients to reduce
the rate of COVID-19 transmission.
Pathophysiologically, stroke occurs due to ischemia or hemorrhage in cerebral blood vessels, contributing to high
mortality and morbidity rates. High morbidity rates have implications for
expensive rehabilitation costs and high dependency rates (Purnamayanti et al.,
2020). Stroke can affect a patient's life in
physical, emotional, psychological, cognitive, and social aspects. The level of
physical and mental disability in post-stroke patients can affect the patient's
quality of life (Fitriani &
Mulyono, 2022). Health information technology can improve
communication between patients and health workers, share information, and
support decision-making (Pudiyanti &
Afriani, 2020). The current telemedicine health service
model provides valuable experience for countries with limited resource
conditions. This is the right motivation to accelerate the implementation of
telemedicine services.
Three types of telemedicine services exist:
synchronous, asynchronous, and remote monitoring. Synchronous monitoring refers
to the delivery of health information in real time. This allows for direct
discussions with patients and doctors to provide medical services. Another type
of live (or synchronous) telemedicine visit is the Facilitated Virtual Visit.
An example of a facilitated virtual visit occurs when the patient is in an
accessible location, i.e., a clinic where diagnostic equipment is available,
and the medical provider is at a distance. Here, a telefacilitator
(i.e., medical assistant or nurse) collects objective measures using equipment
(i.e., digital stethoscope, thermometer, pulse oximeter,
and so on) and transmits this data to the provider. Asynchronous Telemedicine
refers to the "store-and-forward technique.
The patient or doctor collects medical
history, images, and pathology reports and then sends them to specialists for
diagnostic expertise and treatment. Lastly, remote patient monitoring involves ongoing evaluation of the patient's clinical status, either
through live video monitoring of the patient or through a review of tests and
images collected remotely. Newer technologies like mobile device applications
enable broader telehealth possibilities (Fatmawati & Keb,
2021). The scope and benefits of Telemedicine
cover three interrelated sides: patients, doctors, and hospitals. The specific
direct benefits for patients are:
1. Accelerate
patient access to referral centers
2. It is easy to
get help while waiting for direct help from private doctors
3. Patients feel
they remain close to home, where family and friends can provide direct support
4. Reducing
mental stress or tension felt at work
5. They are
selecting patients who need to be taken to the hospital. Patients who do not
need hospital treatment will still stay at home.
Another benefit obtained from Telemedicine
is felt by patients, nurses, and other health workers because, in this case, it
will make monitoring the patient's condition easier. Telemedicine makes it
easier for health workers to reach patients for education related to patient
education to improve the quality of life of stroke patients. This is shown by
the long-distance telephone, SMS, and social media methods. It is also easier
for patients to obtain information related to education to improve the quality
of life of stroke patients through Telemedicine.
Telemedicine hardware and software are
costly, but it is necessary to explain which side can be applied according to
our capabilities and which must wait for high technology. All imaging (image)
delivery, real-time echocardiography, X-ray film imaging, CT scans, or
angiograms require high costs for broadband channels and digital networks.The choice of telecommunications access has
spurred the interest of many healthcare centers in
using Telemedicine for more effective services. Recent research has
demonstrated the diagnostic accuracy of echocardiography in pediatric
patients performed in real-time using broadband microwave and store and forward
using standard telephone lines. The level of accuracy and clarity of the image
is so high that it has encouraged heart health centers
to develop telecardiology networks to serve patients
in suburban areas or small towns.
CONCLUSION
Based on the
research results and discussion above, the role of Telemedicine is considered
very important for treating and providing therapy to patients, which, of
course, is supported by an appropriate diagnosis. Making a correct diagnosis
via Telemedicine is a challenge for doctors because a solid ability to explore
the patient's anamnesis and medical history is essential. Hospitals in
Indonesia have creativity and can adapt to changing times to compete in
improving patients' quality of life. Even though there are still many obstacles
that need to be studied further on how to handle them, such as the absence of
palpation of the patient, supporting examinations such as radiology still have
to be in place, through this systematic review, Telemedicine shows its
advantages in terms of ease in diagnosing diseases such as stroke. Telemedicine
with health interventions through information technology capabilities, whether
smartphones or other wireless networks, provides benefits and opportunities for
the world of health to have a good influence in improving the quality of life
of patients with stroke.
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©
2023 by the authors. It was
submitted for possible
open-access publication under
the terms and conditions of the Creative Commons Attribution (CC BY SA) license
(https://creativecommons.org/licenses/by-sa/4.0/). |