Wolfe C D, Taub N A, Woodrow J, Richardson E, Warburton F G, Burney P G
Division of Community Health, United Medical School, London.
J Epidemiol Community Health. 1993 Apr;47(2):144-8. doi: 10.1136/jech.47.2.144.
To quantify the use of health care services by acutely ill stroke patients in three district health authorities.
A follow up study of all patients recorded in population based registers who had a first ever stroke in three district health authorities, with assessment following the onset and three months after the stroke.
West Lambeth, Lewisham and North Southwark, and Tunbridge Wells District Health Authorities in south east England.
All first time stroke patients under the age of 75 years who presented between 15 August 1989 and 14 August 1990.
Hospital admission rates, rates of use of rehabilitation services, and contact with medical practitioners together with assessment of disability and handicap were determined. A total of 386 strokes were registered. Seventy eight per cent were treated in hospital and younger and incontinent patients were significantly more likely to be admitted. The median stay was 21 days. Patients in West Lambeth, those paralysed, and those who stayed longer in hospital were more likely to receive physiotherapy. Altogether 265 patients were followed up, 117 having died within three months of the stroke. During the three months, 150 (57%) had seen a hospital physician and 181 (69%) their general practitioner, but 18 (7%) had seen neither. Sixty seven (26%) patients were moderately or severely disabled. Twenty seven per cent of inpatients had received no inpatient physiotherapy and 67% of all patients no outpatient physiotherapy during the three months.
The hospital admission rates were high, with long lengths of stay. There were significant differences in the amount of rehabilitation received in each district. This was low overall, especially for those not admitted to hospital. As expected, patients admitted for long periods were the most likely to receive therapy. Before district policies for admission and management of stroke patients can be drawn up, increased knowledge of which aspects of stroke management are effective is needed. Policies should aim to provide planned, coordinated care between hospital and the community. It is striking that many patients received no form of rehabilitation therapy.
量化三个地区卫生当局中急性中风患者的医疗服务使用情况。
对三个地区卫生当局基于人群登记册记录的所有首次中风患者进行随访研究，在中风发作时及发作三个月后进行评估。
英格兰东南部的西兰贝斯、刘易舍姆和南北沃克以及汤布里奇韦尔斯地区卫生当局。
1989年8月15日至1990年8月14日期间出现症状的所有75岁以下首次中风患者。
确定了住院率、康复服务使用率、与医生的接触情况以及残疾和残障评估结果。共登记了386例中风病例。78%的患者接受了住院治疗，年龄较小和大小便失禁的患者入院的可能性显著更高。中位住院时间为21天。西兰贝斯地区的患者、瘫痪患者以及住院时间较长的患者更有可能接受物理治疗。总共对265例患者进行了随访，其中117例在中风后三个月内死亡。在这三个月期间，150例（57%）患者看过医院医生，181例（69%）看过全科医生，但有18例（7%）两者都未看过。67例（26%）患者有中度或重度残疾。在这三个月期间，27%的住院患者未接受住院物理治疗，所有患者中有67%未接受门诊物理治疗。
住院率很高，住院时间很长。每个地区接受的康复治疗量存在显著差异。总体而言康复治疗量较低，尤其是对于未住院的患者。正如预期的那样，长期住院的患者最有可能接受治疗。在制定中风患者的地区入院和管理政策之前，需要更多了解中风管理的哪些方面是有效的。政策应旨在提供医院和社区之间有计划、协调的护理。令人惊讶的是，许多患者没有接受任何形式的康复治疗。
