An Analysis of the Incidence and Cost of Intracranial Aneurysm and Subarachnoid Haemorrhage Treatment between 2013 and 2021.

The incidence of unruptured intracranial aneurysms (UIAs) amounts to 3.2% among adults. The annual risk of aneurysm rupture is 2-10% and it results in subarachnoid haemorrhage (SAH). The aim of this study is to assess changes in the incidence of unruptured intracranial aneurysms and subarachnoid haemorrhages in Poland between 2013 and 2021 and the cost associated with their in-hospital treatment in the acute phase. The analysis was based on the National Health Fund database. Patients diagnosed with UIA and SAH and hospitalised between 2013 and 2021 were chosen. The statistical analysis was performed with an assumed significance level of α = 0.05. The ratio between the prevalence of SAH and UIA diagnoses was 4:6. The proportion of women in relation to men was higher in both diagnoses. The highest proportions of patients with diagnoses SAH and UIA were found in highly urbanised provinces. The value of medical services in 2021 compared to 2013 increased by 81.8%. The highest values in this period were recorded in Mazowieckie province, and the lowest were recorded in Opolskie province. The overall number of patients hospitalised with diagnosis of UIA or SAH did not decrease, but the risk of aneurysm rupture probably decreased, which resulted in lower incidence of SAH in subsequent years of observation. The recorded changes in the dynamics of the value of medical services per patient or per hospitalisation largely coincided. However, it is difficult to speculate on expected value levels as not all provinces showed linear changes in the value of services provided.

Organization of acute stroke services in Poland - Polish Stroke Unit Network development.

BACKGROUND AND PURPOSE: According to the recommendations of stroke organizations, every stroke patient should be treated in a specialized stroke unit (SU). We aimed to evaluate the development of the SU network in Poland during the past decade. MATERIAL AND METHODS: In Poland, stroke is treated mainly by neurologists. A questionnaire evaluating structure and staff of neurological departments was sent to all neurological departments in 2003, 2005 and 2007. In 2010, we collected data based on information from the National Health Fund. We divided departments into categories: with a comprehensive SU, with a primary SU unit, and departments without an SU. Primary SUs were further divided into class A SUs (fulfilling criteria of the National Programme of Prevention and Treatment of Stroke Experts - eligible for thrombolysis), class B (conditionally fulfilling criteria), and class C (not fulfilling criteria). RESULTS: Final analyses included 87.4% of departments (194/222) in 2003, 85.5% of departments (188/220) in 2005, and 83.1% of departments (182/219) in 2007. According to the above-mentioned classification there were 20 class A SUs in 2003, 58 in 2005 and 5 comprehensive and 51 class A SUs in 2007. In 2012, based on information from the National Health Fund there were 150 SUs, all fulfilling criteria for thrombolysis, 9 of them comprehensive SUs. CONCLUSIONS: The SU network in Poland is developing dynamically but thrombolysis and endovascular procedures are done too rarely. Now it is necessary to improve quality of stroke services and to make organizational changes in the in-hospital stroke pathways as well as to organize continuous education of medical staff.

Development of early comprehensive stroke inpatient rehabilitation in Poland - current status and future requirements.

BACKGROUND AND PURPOSE: Every stroke patient should undergo early rehabilitation. We aimed to evaluate accessibility, development and needs in early stroke inpatient rehabilitation in Poland. MATERIAL AND METHODS: A questionnaire evaluating rehabilitation departments was prepared and sent (in 2004 and 2008) to rehabilitation wards in Poland, where stroke patients are treated and undergo early rehabilitation. We divided departments into classes: class A - having comprehensive rehabilitation (physiotherapy minimum 60 minutes/day, speech therapy minimum 30 minutes/5 days/week, rehabilitation of other cognitive impairments minimum 30 minutes/5 days/week, group physiotherapy); B - having the possibility of all types of therapy, but done less frequently; C - physiotherapy and speech therapy; D - physiotherapy and cognitive rehabilitation; E - only physiotherapy. RESULTS: In 2004, we obtained responses from 115 of 172 (66.9%) rehabilitation departments. According to prespecified criteria there were 11 class A, 31 class B, 28 class C, 4 class D, and 41 class E wards. In 2008, we received response from 89 of 149 (59.7%) rehabilitation departments. According to prespecified criteria there were 17 class A, 40 class B, 22 class C, 0 class D, and 10 class E wards. In 2004, 159 beds and in 2008, 294 beds in class A departments were available for stroke patients. The minimal number of needed but lacking beds was 604 in 2004 and 469 in 2008. CONCLUSIONS: Development of departments providing early comprehensive stroke rehabilitation from 2004 to 2008 is marked, but still insufficient. In 2008, 19% of rehabilitation departments could provide comprehensive stroke rehabilitation and this was 38.5% of beds actually needed.

Development of the stroke unit network in Poland--current status and future requirements.

BACKGROUND AND PURPOSE: According to the World Health Organization establishments and European Stroke Initiative recommendations, every patient with stroke should be treated by a specialized stroke team or in a specialized stroke unit. We aimed to evaluate the development of the stroke unit network in Poland and accessibility of stroke units in 2005. MATERIAL AND METHODS: Questionnaires evaluating structure and staff of neurological departments were sent to all neurological departments in Poland in the second quarter of 2005. We divided departments into the following categories: those having a class A stroke unit (fulfilling criteria of experts of the National Programme of Prevention and Treatment of Stroke) class B stroke unit (conditionally fulfilling those criteria), class C stroke units (not fulfilling the criteria), and departments without stroke units. The classification was presented to the chief consultant in neurology of each voivodship in December 2005 for verification of the data. RESULTS: We received enquiries from 180 out of 220 (81.8%) departments. Consultants included data of a further 8 departments which did not respond to the questionnaire (188 - 85.5%). 105 departments declared having a stroke unit (58 class A units, 40 class B units, and 7 class C units). 83 other departments do not have stroke units. The most frequent problem that plays a role in classification of departments was the deficit of staff or lack of equipment. It is assessed that the supplementation of diagnostic equipment and staff in existing stroke units and the establishment of 27 new stroke units is required to satisfy current needs. CONCLUSIONS: The development of the stroke unit network in Poland is proceeding dynamically. There are 105 stroke units in Poland but 45% of them require additional diagnostic equipment and staff.

[An evaluation of the accessibility of early post-stroke comprehensive rehabilitation in Poland]. / Ocena dostepnosci wczesnej kompleksowej rehabilitacji poudarowej w Polsce.

BACKGROUND AND PURPOSE: According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland. MATERIALS AND METHODS: We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff. RESULTS: We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E. CONCLUSION: Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.

[Evaluation of the accessibility of stroke units in Poland]. / Ocena zabezpieczenia chorych z udarem mózgu w zakresie dostepnosci pododdzialów udarowych w Polsce.

BACKGROUND AND PURPOSE: According to the World Health Organization (WHO) assumptions every patient with a stroke should be treated by a specialized stroke team or in a specialized stroke unit. The aim of our study was to evaluate the accessibility and eligibility of stroke units in Poland. MATERIALS AND METHODS: We have developed a questionnaire evaluating the structure and staff of neurological departments. The questionnaire was sent to all neurological departments in Poland in the last quarter of 2003. We grouped the departments in 5 categories: having a stroke unit of class A (fulfilling the criteria of the Experts of the National Program of Prevention and Treatment of Stroke guidelines), class B (conditionally fulfilling the criteria), class C (not fulfilling the criteria), departments having stroke units without a separate structure and departments without stroke units. The classification was shown to each provincial consultant in order to verify our data in January 2004. RESULTS: We have received replies from 194 of 222 (87.4%) departments. 97 departments declared having a stroke unit: 20 -- class A, 56 -- class B, 14 -- class C and 7 -- stroke units without a separate structure. The remaining 97 departments do not have any stroke units. The most frequent problem that plays a role in the classification of departments was the deficit of staff or equipment. CONCLUSIONS: The stroke unit network in Poland is developing dynamically, but a significant number of the existing stroke units need more diagnostic equipment, staff and structural changes.