<i>“The Patient is Practically Abandoned”.</i> Challenges in Post-Stroke Care During the COVID-19 Pandemic in Peru”

Abstract

Background: Stroke care after discharge is complex and usually involves several providers based at different health establishments. In low- and middle-income countries (LMICs), continuity of care is often compromised because of the fragmentation of the health care system which might have worsen during the COVID-19 pandemic. Our study aimed to 1) understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and 2) identify potential opportunities to improve these processes, while contrasting pre and during COVID-19 experiences in Peru. Methods: Qualitative study conducted between February and March 2021 that consisted of in-depth interviews of patients with stroke, their caregivers and health care personnel regarding stroke care at a referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and after discharge. For each phase, we explored experiences, feelings and expectancies using thematic analysis. Results: We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred problems related to communication with health care personnel and an absence of training to provide care at home after discharge. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic health care records, improving the referral system and reinforcing telemedicine services. Conclusions: The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact might have been greater due to the already weak and fragmented health care systems. The COVID-19 pandemic posits an opportunity to improve post stroke care services, and addressing patients’ experiences and feelings in developing solutions in a participatory manner is need. Funding: This study was funded by the Fogarty International Center (NIH Research Training Grant D43:TW009345) through the Northern Pacific Global Health Research Fellows Training Consortium. Declaration of Interest: None to declare. Ethical Approval: This study was evaluated and approved by the Institutional Review Boards of the University of Washington and INCN.