Does British general practice need a helping of doughnut economics?

Abstract

BACKGROUND: Over the last two decades, the need for a longer-term perspective to stroke management has become increasingly recognised. This paper reports a component of a larger project aimed at developing a systematic, primary care-based service for stroke aftercare. AIM: To identify the types and prevalence of longer-term problems experienced by stroke patients and their carers in the United Kingdom (UK). METHOD: Systematically identified quantitative surveys reporting the prevalence of long-term stroke-related problems were reviewed and the findings extracted and interpreted against a patient and carer defined classification system, identified during an earlier review of the qualitative stroke literature. RESULTS: Twenty-seven UK surveys, including approximately 6000 patients and 3000 carers, and two literature reviews were identified by the search methods. Most of the problem areas identified in the qualitative stroke literature review were reported in the quantitative surveys and an additional two problems were identified (falls and sexual problems). The prevalence of problems in each of the areas was as follows: 19% to 62% for emotional problems; 18% to 46% for social problems; 13% to 77% for service issues; 18% to 88% for poor communication; 33% to 100% for transfer of care; and 10% to 73% for other areas. CONCLUSION: This review confirms the findings and recommendations from earlier work about the need for a longer-term holistic approach to the rehabilitation of stroke patients and support for carers. Having established the nature and frequency of the main problems experienced by stroke patients and their carers, the appropriate evidence-based interventions need to be identified and consolidated into a stroke service, facilitated by a robust patient-assessment process.