Abstract
Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients’ characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.
Highlights
Stroke is a disease of acute onset with long standing evolution of complications[1]
In this study we look at the baseline demographic and rehabilitation profiles of post stroke patients receiving care at public primary care health centres across Peninsular Malaysia and their clinical outcomes achieved
This study focused on the secondary prevention of stroke i.e. risk factors management; in which the majority of the cases were managed by primary care physicians despite still having tertiary care appointments
Summary
Stroke is a disease of acute onset with long standing evolution of complications[1]. In low and middle income countries, access to specialised stroke care is fragmented and patchy, concentrated mostly at urban areas[2,3]. In Malaysia, patients who receive treatment for acute stroke in tertiary or secondary hospitals, are usually managed at hospital-based specialist outpatient or primary care clinics after discharge[10]. There is no protocol which addresses the transfer of care from tertiary to primary care for long term post stroke management at community level. Patients or their caregivers have the option to either be followed up at public or private primary care health facilities of their choice. In this study we look at the baseline demographic and rehabilitation profiles of post stroke patients receiving care at public primary care health centres across Peninsular Malaysia and their clinical outcomes achieved. It is hoped that the information from this study will guide improvements in service provision for post stroke patients receiving treatment at public primary care health centres
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