Feasibility study of a primary care-based model for stroke aftercare.

BACKGROUND: A new primary care model for stroke aftercare has been developed to address the longer-term needs of patients who have had a stroke and their families. AIM: To test the feasibility and acceptability of the new model on patients who have had a stroke and their carers. DESIGN OF STUDY: An observational feasibility study. SETTING: Patient and carer assessments and interviews conducted in patients' homes. METHOD: Patients who have had a stroke, and their carers, were assessed using a purposely developed primary care stroke model. Qualified health- and social-care professionals acted as stroke care coordinators and carried out the assessments. Four evaluations were undertaken as part of the study: analysis of care plans, a survey of unmet needs, focus group sessions for staff, and patient/carer interviews. RESULTS: Forty-seven patients and 21 carers were recruited to the study. Analysis of care plans indicated that the assessment process was successful in identifying patient and carer problems (n = 219). Actions were instigated against 190 of these problems and, at 3 months after the assessment, 75% of the problems had been resolved. Patients/carers thought that the review process would be more valuable if conducted sooner after hospital discharge. CONCLUSION: The model was acceptable to professionals, encouraging them to work in a manner more consistent with the expressed needs of patients and carers who were adjusting to the longer-term impact of stroke. Essential aspects informing the care process were also identified. Further work is now required to investigate the effects of the intervention on patient and carer outcomes.

A survey to investigate the role of the district nurse in stroke care.

The long-term needs of people who have had a stroke and their carers are not being adequately addressed. A stroke care coordinator based in primary care might improve service delivery: the district nurse has been suggested as a possible candidate. A postal survey was conducted with three primary care trusts in Bradford to investigate the current role of the district nurse in stroke care and to examine their potential as stroke care coordinator. District nurses from 24 (59%) teams responded to the survey. Twenty-two (44%) were aware of the national clinical guidelines for stroke and five (10%) had received stroke-related training within the previous year. The district nurses demonstrated insight into the types of longer term problems experienced by people who have had a stroke and their carers. While findings of the survey suggests that they would be a likely candidate for the stroke care coordinator role, there are major educational, training and organizational challenges to implementing this change.

Developing a primary care-based stroke model: the prevalence of longer-term problems experienced by patients and carers.

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.

Developing a primary care-based stroke service: a review of the qualitative literature.

The aim of this review was to identify the most frequently encountered longer-term problems experienced by stroke patients and their informal carers. Systematically identified qualitative studies describing self-reported experiences of stroke-related long-term problems were independently reviewed and the findings analysed using a clustering technique. Twenty-three qualitative studies, which included approximately 500 patients and 180 carers, were identified by the search methods. Most of the studies were cross-sectional, United Kingdom-based, and employed semi-structured individual interviews. The review identified 203 problem areas, which were categorised into five domains: hospital experience; transfer of care; communication; services; and social and emotional consequences. The largest domain was the social and emotional consequences of stroke, representing 39% of all problem areas. These included problems relating to mood, social changes, attitudes to recovery, and changes in self-perception and relationships. Service deficiencies, encompassing both health and social care, was the second largest domain, accounting for 29% of the problem areas. The review provides a basis for a user-focused, longer-term stroke service. The need for responses that go beyond the traditional physical rehabilitation approach is evident, and research to identify broader treatment strategies is now required.

Primary care trusts. In the know.

PCTs allow a strategic approach to primary care research that supports collaboration between professionals and practices and reflects local and national priorities. The implementation of a research strategy in one PCT provides a useful working model.