Schwarzbach C J, Eichner F A, Pankert A, Schutzmeier M, Heuschmann P U, Grau A J
Neurologische Klinik, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland.
Nervenarzt. 2020 Jun;91(6):477-483. doi: 10.1007/s00115-020-00909-w.
Registry data demonstrate a high risk of recurrent stroke and rehospitalization rates after first-time stroke in Germany compared to the international level. Meanwhile, a report of the Institute for Applied Quality Assurance in the Healthcare System (aQua institute) pointed out the potential for improvement of post-stroke care in Germany.
To establish perspectives for improvement of outpatient post-stroke care in Germany.
Critical discussion of important aspects of post-stroke care, presentation of the current structures of healthcare provision and possibilities for improvement of post-stroke care.
Post-stroke care in Germany is predominantly carried out by general practitioners. Currently, standard healthcare procedures do not provide a comprehensive supportive system of structured and cross-sectoral aftercare after ischemic stroke. Special attention must be paid to the treatment of cardiovascular risk factors according to the guidelines, a specific and rapid provision of assist devices and physiotherapy as well as prevention and treatment of stroke-associated complications. Previous investigations have revealed sometimes clear deficits in the provision of treatment. The reasons include but are not limited to sectoral barriers that are difficult to overcome. New concepts of post-stroke care for improvement of these deficits are currently undergoing clinical testing.
Ischemic stroke should be considered as a complex chronic disease and should be treated accordingly after discharge from acute inpatient treatment. Emphasis should be placed on the optimization of interdisciplinary and cross-sectoral cooperation and support for general practitioners in the outpatient post-stroke care. New concepts of post-stroke care have the potential for improvement of the current healthcare structures.
登记数据表明，与国际水平相比，德国首次中风后的复发性中风风险和再住院率较高。与此同时，医疗保健系统应用质量保证研究所（aQua研究所）的一份报告指出了德国中风后护理的改进潜力。
为改善德国门诊中风后护理确立观点。
对中风后护理的重要方面进行批判性讨论，介绍当前的医疗保健提供结构以及中风后护理的改进可能性。
德国的中风后护理主要由全科医生进行。目前，标准医疗程序并未提供一个全面的、结构化的和跨部门的缺血性中风后持续护理支持系统。必须特别注意按照指南治疗心血管危险因素，具体且快速地提供辅助设备和物理治疗，以及预防和治疗中风相关并发症。先前的调查有时揭示了治疗提供方面明显的不足。原因包括但不限于难以克服的部门障碍。目前正在对改善这些不足的中风后护理新概念进行临床试验。
缺血性中风应被视为一种复杂的慢性病，急性住院治疗出院后应相应地进行治疗。应强调优化跨学科和跨部门合作，并在门诊中风后护理中支持全科医生。中风后护理的新概念有可能改善当前的医疗保健结构。
