[The continuum of stroke care - a way to make it more cost effective]

A stroke is the most common cause for disability in the adult population. Rehabilitation is the tool to reduce the consequences of impairment. However, the continuum of stroke care is fragmented and rehabilitation is often lacking and unevenly distributed along the care pathway. In order to find potential cost-effective solutions, we have analysed the Swedish stroke care service system by using a three-level framework, i.e. micro, meso, and macro levels. At the micro level, a standardized and regular follow-up including assessment of rehabilitation needs is needed to facilitate effective rehabilitation and timely transition of care. The evidence-based rehabilitation including increasing rehabilitation intensity should be implemented in the whole care chain. At the meso level, a tight collaboration between different medical specialities is necessary to build a cost-effective stroke care. The awareness of rehabilitation needs and possibilities to respond to these require increased education about rehabilitation for the health care staff. Both undergraduate teaching as well as speciality training should include rehabilitation. The use of tele-medicine can be a way forward to provide rehabilitation in the same manner for more people and in different parts of the country.  Together with these micro and meso level solutions, additional recourses need to be prioritized at the macro level in order to facilitate the improvement of the cost-effective continuum of stroke care.