Equitable Access to Stroke Care in Canada – The Geographic Conundrum

Healthcare systems are shaped to best serve the subject population, and the geospatial distribution of the population has an impact on healthcare delivery.The Canadian perspective on stroke care access differs from most of the developed world due to a vast geographic area with low population density.Only four people live per square kilometer of Canada compared to 36 in the USA and 237 in Germany. 1 Although more than 80% of Canadians now live in metropolitan or urban centers, rural is still the way of life for every fifth Canadian.Furthermore, 66% of citizens live within 100 km from the Canada-US border with 33% scattered over 96% of colossal Canada. 2 The relative concentration of population hubs near the southern border may be good for stroke care access to the majority but makes the other 33% even more vulnerable.Despite a gradual trend toward urbanization resulting in an increased share of the non-rural population overtime in relative terms, the absolute number of people living rurally is still increasing.3 Stroke care must be appropriate, safe, efficient, acceptable, accessible, and effective.4 These quality benchmarks are easier to achieve in urban centers, but severe inequalities may appear in rural communities.Lack of access to preventative, restorative, and rehabilitative services in rural Canada can render care non-equitable.Delayed delivery of diagnostic and therapeutic stroke interventions in this time-sensitive disease negatively impacts patient outcomes resulting in care which is neither efficient nor very effective.In this issue of the Canadian Journal of Neurological Sciences, Kapral et al. explored access to stroke care in rural Ontario communities.5 They defined rural as a community with less than 10,000 inhabitants and calculated the total rural population in Ontario as approximately 1.5 million strong.They estimated stroke care access by transport times analyzed for within 30, 60, and 240 min of driving time at posted speeds.Access to stroke care services, including neuroimaging, thrombolysis, endovascular thrombectomy (EVT), stroke unit care, stroke prevention clinics, and inpatient rehabilitation facilities, was assessed.Their data showed that over 90% of rural residents lived within 240 min of drive time for most stroke care services but EVT.They found that EVT access drops rapidly from 83.9% at 240 min to 32.1% at 60 min and only 3.3% at less than 30 min drive.The authors conclude that access to stroke care across rural Ontario communities is reassuringly good with exception of EVT.However, the authors also found a striking access discrepancy between rural residents of northern and southern Ontario across multiple domains of stroke care.For example, almost a third of northern Ontario residents were more than 4 h from MRI, stroke unit care,

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.