Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, South Kensington Campus, London, SW7 2AZ, UK.
Ministry of Health, 'Suwasiripaya', No-385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo-10, Sri Lanka.
BMC Health Serv Res. 2022 Aug 10;22(1):1017. doi: 10.1186/s12913-022-08404-5.
Stroke survivors require continuing services to limit disability. This study assessed the coverage and equity of essential care services received during the first six months of post-stroke follow-up of stroke survivors in the Western Province of Sri Lanka.
A multidisciplinary team defined the essential post-stoke follow-up care services and agreed on a system to categorize the coverage of services as adequate or inadequate among those who were identified as needing the said service. We recruited 502 survivors of first ever stroke of any type, from 11 specialist hospitals upon discharge. Six months following discharge, trained interviewers visited their homes and assessed the coverage of essential services using a structured questionnaire.
Forty-nine essential post-stroke follow-up care services were identified and categorized into six domains: monitoring of risk conditions, treatment, services to limit disabilities, services to prevent complications, lifestyle modification and supportive services. Of the recruited 502 stroke survivors, 363 (72.3%) were traced at the end of 6 months. Coverage of antiplatelet therapy was the highest (97.2% (n = 289, 95% CI 95.3- 99.1)) while referral to mental health services (3.3%, n = 12, 95% CI 1.4-5.1) and training on employment for the previously employed (2.2%, n = 4, 95% CI- 0.08-4.32), were the lowest among the six domains of care. In the sample, 59.8% (95% CI 54.76-64.48) had received an 'adequate' level of essential care services related to treatment while none received an 'adequate' level of services in the category of support services. Disaggregated service coverage by presence and type of limb paralysis within the domain of services to prevent complications, and by sex and education level within the domain of education level, show statistically significant differences (p < 0.05).
Apart from treatment services to limit disabilities, coverage of essential care services during the post-stroke period was inadequate. There were no apparent inequities in the coverage of vast majority of services. However focused policy decisions are required to address these gaps in services.
中风幸存者需要持续的服务来限制残疾。本研究评估了斯里兰卡西部省中风幸存者在中风后六个月的随访期间接受基本护理服务的覆盖范围和公平性。
一个多学科团队定义了基本的中风后随访护理服务，并就如何将服务的覆盖范围归类为充分或不足达成一致，适用于那些被认为需要上述服务的人。我们从 11 家专科医院招募了 502 名首次任何类型中风的幸存者，在出院后进行评估。出院后 6 个月，经过培训的访谈者访问他们的家庭，并使用结构化问卷评估基本服务的覆盖范围。
确定了 49 项基本的中风后随访护理服务，并将其分为六个领域：监测风险状况、治疗、限制残疾的服务、预防并发症的服务、生活方式改变和支持性服务。在招募的 502 名中风幸存者中，有 363 名（72.3%（n=289，95%CI 95.3-99.1））在 6 个月结束时被追踪到。抗血小板治疗的覆盖率最高（97.2%（n=289，95%CI 95.3-99.1）），而向心理健康服务机构转诊（3.3%，n=12，95%CI 1.4-5.1）和为以前就业的人提供就业培训（2.2%，n=4，95%CI-0.08-4.32）的覆盖率最低，在护理的六个领域中。在样本中，59.8%（95%CI 54.76-64.48）接受了与治疗相关的“足够”水平的基本护理服务，而在支持服务类别中则没有接受“足够”水平的服务。在预防并发症领域，根据肢体瘫痪的存在和类型以及教育领域的性别和教育水平，服务覆盖情况存在显著差异（p<0.05）。
除了治疗残疾的服务外，中风后期间基本护理服务的覆盖范围不足。绝大多数服务的覆盖范围没有明显的不平等。然而，需要做出有针对性的政策决策来解决这些服务差距。
