What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

Aziz, Aznida Firzah Abdul, Aziz, Noor Azah Abd, Nordin, Nor Azlin Mohd, Ali, Mohd Fairuz, Sulong, Saperi and Aljunid, Syed M., (2013). What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic. Journal of Neurosciences in Rural Practice, 4(4), 413-420

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    Author Aziz, Aznida Firzah Abdul
    Aziz, Noor Azah Abd
    Nordin, Nor Azlin Mohd
    Ali, Mohd Fairuz
    Sulong, Saperi
    Aljunid, Syed M.
    Title What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic
    Appearing in Journal of Neurosciences in Rural Practice
    Volume 4
    Issue No. 4
    Publication Date 2013-12-01
    Place of Publication n/a
    Publisher Journal of Neurosciences in Rural Practice
    Start page 413
    End page 420
    Language English
    Abstract Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care?driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long?term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1?year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t?tests or Wilcoxon?signed rank test. Significance level was set at 0.05. Results: Ninety?one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2?100) to 90.5 (range: 27?100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0?22) to 3.0 (range: 0?19) though the change was not significant (Z= ?0.744, P = 0.457). Conclusions: Primary care?driven long?term stroke care services yield favorable outcomes for blood pressure control and functional level.
    Keyword Long-term stroke care
    Poststroke
    Primary care
    Copyright Holder Wolters Kluwer
    Copyright Year 2013
    Copyright type All rights reserved
    DOI 10.4103/0976?3147.120243
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    Created: Wed, 11 Jun 2014, 16:20:18 JST