Shahjouei Shima, Bavarsad-Shahripour Reza, Assarzadegan Farhad, Rikhtegar Reza, Mehrpour Masoud, Zamani Babak, Tsivgoulis Georgios, Alexandrov Andrei, Alexandrov Anne, Zand Ramin
Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurology, University of Alabama, Birmingham, Alabama, USA.
Iran J Neurol. 2017 Apr 4;16(2):62-71.
Stroke is among the leading causes of mortality and permanent disability in the world. Iran is located in the stroke belt and has a high age-adjusted stroke incidence rate. In this multistep prospective qualitative study, we aimed at investigating the status and challenges of stroke management in Iran and explore possible solutions. In the first and second phase, we attempted to define the status of stroke management in Iran by searching the relevant literature and conducting semi-structured interviews with health-care providers in thirteen hospitals located in seven large cities in Iran. In the third phase, we tried to recommend possible solutions based on international standards and experience, as well as interviews with stroke experts in Iran and the United States. Little public awareness of stroke symptoms and its urgency, low prioritization for stroke management, and an inadequate number of stroke-ready hospitals are some of the major obstacles toward timely treatment of stroke in Iran. Every hospital in our pool except two hospitals had guideline-based algorithms for the administration of intravenous thrombolysis. However, there was no single call activation system for stroke alert. Data from some of the centers showed that hospital arrival of stroke patients to final decision-making took 116-160 minutes. Although there were four endovascular programs in our target areas, there was no center with 24-hour coverage. There are many challenges as well as potentials for improvement of stroke care in Iran. Improving public knowledge of stroke and establishing an organized and comprehensive stroke program in the hospitals will improve acute stroke management in Iran. The Iranian ministry of health should define and advocate the establishment of stroke centers, track the rate of death and disability from stroke, introduce pathways to improve the quality of stroke care through national data monitoring systems, and eliminate disparities in stroke care.
中风是全球主要的死亡和永久性残疾原因之一。伊朗位于中风高发地带，年龄调整后的中风发病率很高。在这项多步骤前瞻性定性研究中，我们旨在调查伊朗中风管理的现状和挑战，并探索可能的解决方案。在第一和第二阶段，我们试图通过检索相关文献以及对伊朗七个大城市的13家医院的医疗服务提供者进行半结构化访谈来确定伊朗中风管理的现状。在第三阶段，我们试图根据国际标准和经验，以及对伊朗和美国中风专家的访谈，推荐可能的解决方案。公众对中风症状及其紧迫性的认识不足、对中风管理的优先级较低以及具备中风救治能力的医院数量不足，是伊朗及时治疗中风的一些主要障碍。我们所调查的医院中，除了两家医院外，每家医院都有基于指南的静脉溶栓给药算法。然而，没有单一的中风警报呼叫激活系统。一些中心的数据显示，中风患者从入院到最终决策需要116 - 160分钟。尽管我们的目标地区有四个血管内治疗项目，但没有一个中心提供24小时服务。伊朗在中风护理方面既有许多挑战，也有改进的潜力。提高公众对中风的认识，并在医院建立有组织、全面的中风项目，将改善伊朗的急性中风管理。伊朗卫生部应界定并倡导建立中风中心，跟踪中风的死亡率和致残率，通过国家数据监测系统引入提高中风护理质量的途径，并消除中风护理方面的差异。
