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Stroke Care in an Australian Rural Private Health Care Setting

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ABSTRACT
Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.
 
Cite this paper
Vijiaratnam, N. , Yan, B. , Anjara, P. , Kraemer, T. , Lau, M. and Knight, B. (2015) Stroke Care in an Australian Rural Private Health Care Setting. World Journal of Neuroscience, 5, 7-12. doi: 10.4236/wjns.2015.51002.
 
References
[1]Senes, S. (2006) How We Manage Stroke in Australia. AIHW Cat. No. CVD 31. Australian Institute of Health and Welfare, Canberra.
 
[2](2008) Australian Bureau of Statistics. 3303.0 Causes of Death 2206: Australia. Report No. 3303.0, Canberra.
 
[3]Stroke Unit Trialists’ Collaboration (2003) Organised Inpatient (Stroke Unit) Care for Stroke (Cochrane Review). Oxford: Update Software. Cochrane Database of Systematic Reviews, 2003, Article ID: CD000197.
 
[4]Joubert, J., Prentice, L.F., Moulin, T., et al. (2008) Stroke in Rural Areas and Small Communities. Stroke, 39, 1920-1928. http://dx.doi.org/10.1161/STROKEAHA.107.501643
 
[5]Cadilhac, D.A., Kilkenny, M.F., Longworth, M., et al. (2011) Metropolitan-Rural Devide for Stroke Outcomes: Do Stroke Units Make a Difference? Internal Medicine Journal, 41, 321-326.
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[6]Read, S.J. and Levy, J. (2005) Differences in Stroke Care Practices between Regional and Metropolitan Hospitals. Internal Medicine Journal, 35, 447-450.
 
[7]Cadilhac, D., Ibrahim, J., Pearce, D., et al. (2004) Multicentre Comparison of Processes of Care between Stroke Units and Conventional Care Wards in Australia. Stroke, 35, 1035-1040.
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[8]Cadilhac, D., Lannin, N., Anderson, C., et al. (2013) The Australian Stroke Clinical Registry Annual Report 2012. The Florey Institute of Neuroscience and Mental Health, Report No. 4, 52.
 
[9]Rey, V., Faouzi, M., Huchmand-Zadeh, M., et al. (2011) Stroke Initial Severity and Outcome Relative to Insurance Status in a Universal Health Care System in Switzerland. European Journal of Neurology, 18, 1094-1097. http://dx.doi.org/10.1111/j.1468-1331.2010.03264.x
 
[10]Mccann, L., Groot, P., Charnley, C., et al. (2009) Excellence in Regional Stroke Care: An Evaluation of the Implementation of a Stroke Care Unit in Regional Australia. Australian Journal of Rural Health, 17, 273-278. http://dx.doi.org/10.1111/j.1440-1584.2009.01098.x
 
[11]Jaech, E., Saver, J., Adams, H., et al. (2013) Guidelines for the Early Management of Patients with Acute Ichemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 44, 870-947.
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[12]Zaidi, S., Jumma, M., Urra, X., et al. (2011) Telestroke-Guided Intravenous Tissue-Type Plasminogen Activator Treatment Achieves a Similar Clinical Outcome as Thrombolysis at a Comprehensive Stroke Center. Stroke, 42, 3291-3293. http://dx.doi.org/10.1161/STROKEAHA.111.625046                                       eww150115lx
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