Grant: Catalyst Grant: Quadruple Aim and Equity

Every 9 minutes, someone in Canada experiences a stroke. Stroke is the third most common cause of death among Canadians. Risk factors for stroke include high blood pressure (hypertension), sugar (diabetes), cholesterol (hyperlipidemia), and an irregular heart rhythm (atrial fibrillation). Regular visits to the doctor's office are important for diagnosing these stroke risk factors early and starting treatments to reduce the risk of stroke. The COVID19 pandemic has dramatically changed these visits from in-person to phone or video encounters. Despite the new and widespread use of telemedicine, it is not clear if all regular stroke or vascular health care can be maintained. We will study stroke care and outcomes in residents of Ontario, Canada. Compared to before the pandemic, we will evaluate whether doctor visits, screening for vascular risk factors, and unplanned medication interruptions have been negatively impacted during the pandemic, despite the availability of telemedicine. We will study people without stroke and those who had a hospitalization for stroke. We suspect that care after a hospitalization can be maintained with telemedicine because these patients are well connected with the health system. However, in Ontarians who have chronic vascular conditions without any hospitalization, we suspect doctor visits and regular care may be reduced or delayed. We will identify patient groups who may be particularly vulnerable to difficulties with telemedicine, including those who are older, women, those who experience socioeconomic deprivation, or who live in rural regions. Our research team will be working closely with policymakers and stroke organizations in Ontario and nationally. This study will help us understand if telemedicine is a good tool to enable regular health care to continue when in-person care is not possible, and it will inform policies to better support individuals who have difficulty accessing telemedicine.