Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St, Stephen's Green, Dublin 2, Ireland.
BMC Health Serv Res. 2012 May 6;12:111. doi: 10.1186/1472-6963-12-111.
The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement.
The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate).
Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients.
This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.
中风相关残疾的严重程度通常在患者出院后进入社区时最为明显。作为爱尔兰中风护理国家审计（INASC）的一部分，对社区内的联合健康专业人员和公共卫生护士进行了全国性调查。目的是记录社区中风患者服务可用性面临的挑战，并确定服务改进的重点。
这是一项针对关键管理和服务提供人员的跨部门定制访谈调查。由于没有全面列出参与中风护理的社区卫生专业人员，因此采用了信息收集的级联方法。采访了纳入中风护理服务的服务代表性区域经理（N=7）和纪律联合健康专业人员和公共卫生护士经理（N=25）（响应率为 94%）。
结果表明，缺乏针对中风的正式、结构化的社区服务，全国范围内没有指定的跨学科中风护理临床岗位。各地区联合健康专业人员的可用性存在显著差异。在患者获得中风服务方面存在明显的不公平现象，较年长的患者（≥65 岁）获得的服务更多。缺乏中风策略和中风患病率统计数据被认为是服务规划的重大障碍，组织障碍限制了额外联合健康专业人员的招聘，以及缺乏对患者特定学科信息的共享。
这项研究突出了一个国家为中风患者提供跨学科团队社区服务方面的主要差距。在存在服务的地方，它们的性质通常是通用的，很少具有跨学科的功能，并且缺乏来自重要学科的投入。优化护理的挑战包括需要战略规划；增加医疗保健人员的资金投入；增加团队资源和团队合作；以及消除基于年龄的服务提供障碍。除了资金问题外，还存在许多挑战。在其他医疗保健系统中进行类似的评估将提供有价值的经验教训，以解决中风患者及其家属这一服务不足的方面。
