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[Outpatient management of stroke patients from the viewpoint of general practitioners in Hamburg--an exploratory
A Barzel1, M Eisele, H van den Bussche
1Wissenschaftliche Mitarbeiterin, Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf. a.barzel@uke.uni-hamburg.de
Insights
General practitioners (GPs) find challenges in managing chronic stroke patients post-discharge, with limited success in lifestyle behavior change. Improving interdisciplinary cooperation is crucial for enhancing outpatient stroke care quality.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- Stroke is a chronic disease with significant ambulatory care needs.
- General practitioners (GPs) are primary caregivers for stroke patients post-hospitalization.
- Limited understanding exists regarding the quality of outpatient stroke care.
Purpose of the Study:
- To explore the perspectives of healthcare professionals on outpatient stroke care.
- To identify challenges and areas for improvement in the management of chronic stroke patients.
Main Methods:
- A postal survey was conducted among 443 general practitioners (GPs) in Hamburg, Germany.
- Results were compared with a parallel survey of physiotherapists and occupational therapists.
- 89 questionnaires were analyzed, yielding a 28% response rate.
Main Results:
- Ambulatory care issues may originate during inpatient treatment.
- GPs perceive therapeutic benefits for only half of their chronic stroke patients.
- GPs report effectiveness in medication management but struggle with patient lifestyle behavior change.
- Estimated prevalence of post-stroke depression varies widely (mean 47%).
- 60% of GPs find clinical guidelines unhelpful in daily practice.
- GPs and therapists engage in case management duties beyond their core professional roles.
Conclusions:
- Outpatient stroke care is a complex, multidisciplinary task.
- Further analysis of the rehabilitation process and interdisciplinary cooperation is needed.
- Improving collaboration among healthcare professionals is essential for enhancing outpatient stroke care quality.
Objective:
Stroke is the archetype of a chronic disease, with a considerable burden on ambulatory care. After discharge from hospital or inpatient rehabilitation, stroke patients are attended primarily by general practitioners (GPs). Little is known about the quality of outpatient care for stroke patients, so this study focused on the views of professionals involved in outpatient care.
Methods:
A postal survey of 443 general practitioners from Hamburg, Germany was undertaken. Results were compared with a parallel survey carried out with physiotherapists and occupational therapists.
Results:
89 questionnaires were analysed. Based on a response rate of 28% the results cannot be seen as representative, but they do provide important information. As it seems, problems in ambulatory care do not start after discharge from hospital, but are partly caused by inpatient care. GPs see therapeutic benefits in ambulatory care for only half of their chronic stroke patients. They assess their own therapeutic efforts as effective in terms of medication, but they are less successful in changing their patients' behaviour with regard to lifestyle. Estimations of the prevalence of post-stroke depression vary substantially, with a mean of 47%. With regard to their daily practice, 60% of GPs do not find guidelines to be helpful. All in all, respondents describe the situation of chronic stroke patients and their families to be complex and difficult to manage. In addition to their professional performance, GPs carry out duties related to case management - as do the therapists.
Conclusion:
The care of stroke patients is not only the responsibility of a single group of professionals, but is a rather complex task involving different health-care professionals. The rehabilitation process and the interdisciplinary cooperation need to be further analysed to ensure a good cooperation between health-care professionals and to improve the quality of ambulatory care for stroke patients.
