Abdul Aziz Aznida F, Mohd Nordin Nor Azlin, Abd Aziz Noor, Abdullah Suhazeli, Sulong Saperi, Aljunid Syed M
United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia.
BMC Fam Pract. 2014 Mar 2;15:40. doi: 10.1186/1471-2296-15-40.
Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.
A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.
Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on 'as needed' basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS' perceived 4 important 'needs' in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.
Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.
发展中国家的中风后护理工作因服务不协调和获得专科护理的机会有限而受到阻碍。尽管存在不足，但初级保健仍在不太有利的情况下提供中风后服务。本文旨在回顾管理公共初级卫生保健服务的家庭医学专家提供的中风后护理及相关问题。
在一项旨在改善社区层面中风后护理服务的试点调查中，向121名在公共资助的健康中心服务的家庭医生发放了一份半结构化问卷。该问卷评估了受访者的背景和实践细节，即估计的中风护理负担、当前的服务提供情况以及对服务改进的意见。均值和频率描述了定量数据。对于定性数据，采用持续比较法，直到主题饱和。
获得了48.8%的回复率。每月在公共卫生中心就诊的每100名患者中，有2名患有中风。每月诊治的中风患者中位数为5名（四分位间距为2 - 10）。57.6%的受访者估计每个中心每年治疗的中风患者总数少于40名。72.4%的受访者缺乏标准护理计划，尽管96.6%的受访者同意需要一个标准护理计划。所诊治的患者包括：从三级护理机构出院的患者（88.1%）、与专科医生共享护理计划的患者（67.8%）以及在初级保健随访期间发生中风的患者（64.4%）。随访间隔为每8 - 12周一次（60.3%），3.4%的随访是“按需”进行。在公共设施中，转诊频率依次为物理治疗服务、营养师以及言语和语言病理学家。家庭医学专家认为在初级保健层面管理中风患者有4项重要“需求”；获得康复服务、采用多学科护理方法在三级中心和初级保健之间进行协调护理、标准化指南以及家庭和护理人员支持。
对于居住在社区家中的中风后患者，需要有出院后中风护理指南以及在初级保健机构获得康复服务。
