Surveillance of medical resources for stroke in rural Japan through the Jichi medical university alumni network.

Background: Japan's rapidly aging population has made equitable delivery of stroke care a national priority. However, the status of medical resources in remote regions remains unclear. Methods: A questionnaire survey was distributed in 2017-2018 to the Jichi Medical University alumni network, whose members provide medical care in rural communities and outlying islands. Results: A total of 385 responses were received (response rate = 44.8%), and 236 responses from institutes in rural or island regions were analyzed. The median number of physicians per institute was two in rural areas and one on islands, with approximately 80% specializing in general internal medicine. Among 4569 patients with stroke or transient ischemic attack, including 2860 with ischemic stroke, 95 (3.3%) received intravenous tissue plasminogen activator and 27 (0.95%) underwent mechanical thrombectomy. Computed tomography was available in 116 institutes (49.2%), and carotid ultrasonography in 174 (73.7%). Antithrombotic therapy was available in approximately 60% of institutes. Of respondents, 185 of 201 (92.0%) in rural areas and 31 of 32 (96.9%) on islands recognized the need for stroke care education, while 132 (65.7%) and 25 (78.1%), respectively, expressed demand for telestroke support. However, telestroke systems were available in only 36 rural institutes (17.6%) and 13 islands (40.6%). Conclusions: This study reveals the substantial unmet need for stroke care resources in rural and remote settings. While the availability of physicians and imaging devices has partially improved, major challenges remain, including unequal access to reperfusion therapy, limited supply of essential medications, and insufficient telemedicine infrastructure.