Patterns of acute stroke care in three districts of southern England

Abstract

Objective: To quantify the use of health care services by acutely ill stroke patients in three district health authorities.

Design: A follow up study of all patients recorded in population based registers who had a first ever stroke in three district health authorities, with assessment following the onset and three months after the stroke.

Setting: West Lambeth, Lewisham and North Southwark, and Tunbridge Wells District Health Authorities in south east England.

Subjects: All first time stroke patients under the age of 75 years who presented between 15 August 1989 and 14 August 1990.

Measurements and main results: Hospital admission rates, rates of use of rehabilitation services, and contact with medical practitioners together with assessment of disability and handicap were determined. A total of 386 strokes were registered. Seventy eight per cent were treated in hospital and younger and incontinent patients were significantly more likely to be admitted. The median stay was 21 days. Patients in West Lambeth, those paralysed, and those who stayed longer in hospital were more likely to receive physiotherapy. Altogether 265 patients were followed up, 117 having died within three months of the stroke. During the three months, 150 (57%) had seen a hospital physician and 181 (69%) their general practitioner, but 18 (7%) had seen neither. Sixty seven (26%) patients were moderately or severely disabled. Twenty seven per cent of inpatients had received no inpatient physiotherapy and 67% of all patients no outpatient physiotherapy during the three months.

Conclusions: The hospital admission rates were high, with long lengths of stay. There were significant differences in the amount of rehabilitation received in each district. This was low overall, especially for those not admitted to hospital. As expected, patients admitted for long periods were the most likely to receive therapy. Before district policies for admission and management of stroke patients can be drawn up, increased knowledge of which aspects of stroke management are effective is needed. Policies should aim to provide planned, coordinated care between hospital and the community. It is striking that many patients received no form of rehabilitation therapy.