Wasserman Sean, de Villiers Linda, Bryer Alan
Department of Medicine, Groote Schuur Hospital, Cape Town.
S Afr Med J. 2009 Aug;99(8):579-83.
To develop a community-based model of stroke care, we assessed discharge planning of stroke patients, available resources and continuity of care between hospital and community in a remote rural setting in South Africa. We sought to determine outcomes, family participation and support needs, and implementation of secondary prevention strategies.
Thirty consecutive stroke patients from the local hospital were assessed clinically (including Barthel index and modified Rankin scores) at time of discharge and re-assessed 3 months after discharge in their homes by a trained field worker using a structured questionnaire.
Two-thirds of all families received no stroke education before discharge. At discharge, 27 (90%) were either bed- or chair-bound. All patients were discharged into family care as there was no stroke rehabilitation facility available to the community. Of the 30 patients recruited, 20 (66.7%) were alive at 3 months, 9 (30%) had died, and 1 was lost to follow-up. At 3 months, 55% of the remaining cohort were independently mobile compared with 10% at discharge. Of the 20 surviving patients, 13 (65%) were visited by home-based carers. Only 45% reported taking aspirin at 3 months.
The 3-month mortality rate was high. Most survivors improved functionally but were left with significant disability. Measures to improve family education and the level of home-based care can be introduced in a model of stroke care attempting to reduce carer strain and reduce the degree of functional disability in rural stroke patients.
为建立基于社区的卒中护理模式，我们评估了南非偏远农村地区卒中患者的出院计划、可用资源以及医院与社区之间护理的连续性。我们试图确定治疗结果、家庭参与情况和支持需求，以及二级预防策略的实施情况。
对当地医院连续收治的30例卒中患者在出院时进行临床评估（包括巴氏指数和改良Rankin评分），并在出院3个月后由一名经过培训的现场工作人员使用结构化问卷在患者家中进行重新评估。
三分之二的家庭在出院前未接受过卒中教育。出院时，27例（90%）患者需卧床或坐轮椅。由于社区没有卒中康复设施，所有患者均出院回家接受家庭护理。在招募的30例患者中，20例（66.7%）在3个月时存活，9例（30%）死亡，1例失访。3个月时，其余队列中55%的患者能够独立活动，而出院时这一比例为10%。在20例存活患者中，13例（65%）接受了上门护理人员的探访。3个月时，只有45%的患者报告服用了阿司匹林。
3个月死亡率较高。大多数幸存者功能有所改善，但仍有明显残疾。在卒中护理模式中可以采取措施改善家庭教育和上门护理水平，以减轻护理负担，降低农村卒中患者的功能残疾程度。
