Abstract
BackgroundThe extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement.MethodsThe study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate).ResultsResults indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients.ConclusionsThis study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.
Highlights
The extent of stroke-related disability typically becomes most apparent after patient discharge to the community
Health services in Ireland are provided by the Health Services Executive (HSE), which is organised into four administrative geographic regions
These included local health office (LHO) managers who were responsible at regional level for management and care of people with stroke, public health nurse managers and all allied health professional managers with potential involvement in stroke care in the community
Summary
The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. Half of survivors of an acute stroke make a complete recovery [1]. The stroke patient has to assume increased responsibility for independent functioning in the absence of the supportive environment of the acute phase inpatient hospital setting. Patients frequently have persisting clinical problems including impaired upper and lower limb function, speech and cognitive problems, difficulties mobilising indoors, outdoors and on stairs, limited independence in self care, depression, and social inactivity [5]. Continuity of services is important but many reports describe unmet service and information needs of stroke patients and families following discharge from hospital [6,7]. A study of this type could provide valuable insights into barriers and enablers for the development of high-quality rehabilitation and support services in the community
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