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Critical factors determining access to acute stroke care
S C Menon1, D K Pandey, L B Morgenstern
1Department of Neurology, The University of Texas Medical School, Houston, USA.
Neurology
|August 26, 1998
Summary
Gender and access to care significantly impact acute stroke delay times. Women and Hispanic Americans experienced longer delays in receiving critical stroke care, highlighting disparities in emergency medical services.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Limited data exists on how gender, ethnicity, and access to care influence delay times for acute stroke presentation.
- Understanding these factors is crucial for improving timely stroke interventions.
Purpose of the Study:
- To evaluate the impact of gender, ethnicity, and access-to-care factors on delay time for hospital presentation in acute stroke patients.
- Identify key determinants contributing to delays in stroke care.
Main Methods:
- Retrospective analysis of emergency department (ED) documentation for 241 acute stroke patients admitted between July 1995 and June 1997.
- Utilized univariate and multivariate regression analyses to assess demographic, access-to-care, and delay time data.
Main Results:
- Median delay time from symptom onset to ED presentation varied by ethnicity: 222 minutes for African Americans (AA), 280 minutes for Hispanic Americans (HA), and 230 minutes for non-Hispanic Whites (NHW).
- Multivariate analysis indicated longer delays to ED arrival for women (p=0.052) and those with a primary care physician (p=0.145), while ambulance transport reduced delays (p=0.003).
- Delays to ED physician and neurologist assessment were also longer for women and varied by stroke type and severity, with only 18% of HAs seen by a neurologist within 3 hours of symptom onset.
Conclusions:
- Gender and access-to-care issues are significant factors contributing to delays in acute stroke management.
- Hispanic Americans face substantial delays, with less than 20% receiving timely neurological evaluation, indicating critical disparities in stroke care access.