Aziz Aznida Firzah Abdul, Aziz Noor Azah Abd, Nordin Nor Azlin Mohd, Ali Mohd Fairuz, Sulong Saperi, Aljunid Syed Mohamed
United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia ; Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
J Neurosci Rural Pract. 2013 Oct;4(4):413-20. doi: 10.4103/0976-3147.120243.
Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community.
We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level.
A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility.
Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI).
Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05.
Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2-100) to 90.5 (range: 27-100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0-22) to 3.0 (range: 0-19) though the change was not significant (Z= -0.744, P = 0.457).
Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.
发展中国家的中风后护理存在协调性差和缺乏专业中风护理提供者的问题。以初级保健为主导的卫生服务是确保为社区中居家的中风患者提供最佳护理的一种选择。
我们评估了一个在社区层面结合二级预防和康复的长期中风护理试点诊所的效果。
对2008年至2010年在一家初级保健教学机构接受治疗的中风患者进行前瞻性观察研究。
在初次接触时和治疗后1年对患者进行分析。临床结果包括中风危险因素控制、根据患者健康问卷（PHQ9）评估的抑郁情况以及使用巴氏指数（BI）评估的独立程度。
使用配对t检验或Wilcoxon符号秩检验比较基线和治疗后的均值差异。显著性水平设定为0.05。
对91名患者进行了分析。他们的平均年龄为62.9岁[标准差（SD）10.9]，平均中风发作次数为1.30次（SD 0.5）。急性中风与首次到诊所就诊之间的中位间隔为4.0个月（四分位间距9.0）。平均收缩压下降了9.7 mmHg（t = 2.79，P = 0.007）,而平均舒张压保持在80 mmHg不变（z = 1.87，P = 0.06）。84.6%的患者接受了神经康复治疗。BI中位数从81（范围：2 - 100）增加到90.5（范围：27 - 100）（Z = 2.34，P = 0.01）。PHQ9中位数得分从4.0（范围：0 - 22）降至3.0（范围：0 - 19），尽管变化不显著（Z = -0.744，P = 0.457）。
以初级保健为主导的长期中风护理服务在血压控制和功能水平方面产生了良好的效果。
