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Post stroke care model for patients residing at home in the community (Reproduced with permission from Aznida FAA, 2015)
Source publication
Background:
Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stro...
Context in source publication
Context 1
... this phase, the care algorithms that were mapped out in Phase 1 were then modeled to address both the phys- ical and psychosocial components of post stroke man- agement at the community level (Fig. 1). The current post stroke care provision at these public primary care health centers primarily focuses on the management of stroke risk factors, with rehabilitation aspects mainly not coordinated or made known to the receiving primary care team due to poor transfer of care from tertiary to primary care health ...
Citations
... Early intervention can reduce the prevalence and minimize the disabling effects of chronic conditions among adults and children. Integrating rehabilitation into primary health [6] care can also optimize the outcomes of other kinds of health interventions (surgical or psychological) by facilitating continuity of care that supports full recovery. [5,7] Clinical Pearls for Family Physicians and Primary Care Practitioners 1) The above case illustrates that primary care practitioners should consider postural variation of headache as a red flag. ...
A BSTRACT
Chronic subdural hematoma (CSDH) is a great mimicker. It should be considered in anyone presenting with chronic headaches that show postural variation. Parkinsonism following CSDH, while known, is only rarely reported in the literature. Hyponatremia, rapid correction of hyponatremia, medications, and mechanical pressure are thought to be risk factors. Here, we report a case of a 61-year-old male diagnosed with bilateral CSDH managed by craniotomy and clot evacuation who developed parkinsonism. We share several learnings (clinical pearls) that emerged from the close collaboration and co-learning curve between a family physician and physiotherapist involved in home-based rehabilitation. In conclusion, while managing the postoperative course of patients with CSDH, clinicians should maintain a high index of suspicion for parkinsonism. Early recognition and appropriate management with syndopa with supportive physiotherapy results in significant improvement of function and quality of life. Notably, parkinsonism following SDH is transient and nonprogressive and may not require lifelong therapy.
... Among the clients accessing rehabilitation services, neuromusculoskeletal and movement-related functions were the most prevalent disabilities, followed by mental function (b1) disabilities. These findings are consistent with global trends, emphasising the high prevalence of musculoskeletal and neurological conditions and the importance of addressing mental health within rehabilitation services [26,43,44]. This aligns with international studies where physiotherapists and occupational therapists treating adults confirmed they most frequently provide interventions for clients with these conditions using a PHC approach [45]. ...
Background
Primary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.
Methods
A retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.
Results
The findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.
Conclusion
This study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.
... (e.g., shared vision and values) [13,14], brazil [15][16][17][18], China [19][20][21][22], india [23,24], iran [25][26][27], Kenya [28], lebanon [29], Madagascar [30,31], Malaysia [32][33][34], Pakistan [35], Peru [36], Philippines [37,38], south africa [39][40][41][42], thailand [43,44], turkey [45], Uganda [46,47], Ukraine [48], Vietnam [49,50], Zambia [51], Zimbabwe [52]. studies from multiple countries: africa [53], (Cambodia, nepal, independent republic of somaliland) [54], (Pakistan, Morocco, nigeria and Malaysia) [56], (south arica, botswana, Malawi) [55] type of study Qualitative [13,21,22,25,27,33,39,42,47,51,55], mixed methods [14,19,40,41,44,45,49,52], cross-sectional [15][16][17]20 [15][16][17]19,20,22,25,27,28,30,33,36,41,47,49,50], Clinic-based [13,14,16,25,28,37,[39][40][41]46,54], iCU [19,21,22,29,45,49,52], home-based [15,24,41,51], community-based rehabilitation [23,42,43], University-based [46], mobile rehabilitation unit [18] type of service providers [15][16][17]19,20,23,29], mobilisation & strengthening [28,39,43,45,52], assistive devices [13,28,40,44,51,53], prevention, early identification & screening [16,23,37,42,55], surgery [15,16,19], home-based rehabilitation [15,24,27], pulmonary rehabilitation [15], geriatrics [15], burns [47] (n = 1, 2.2%). Personnel providing physical rehabilitation mentioned in the studies were physiotherapists (n = 28, 63.6%), physicians (n = 20, 45.4%), nurses (n = 17, 38.6%), occupational therapists (OTs) (n = 12, 27.2%), prosthetists and orthotists (n = 9, 20.4%), speech and language pathologists (n = 9, 20.4%), mental health care providers (n = 5, 11.3%), therapists (n = 4, 9%), medical practitioners (n = 5, 11.3%), village health volunteers or community health care workers (n = 5, 11.3%), social workers (n = 3, 6.8%), exercise specialists (n = 2, 4.5%), dieticians (n = 3, 6.8%), and audiologists (n = 2, 4.5%). ...
... (e.g., shared vision and values) [13,14], brazil [15][16][17][18], China [19][20][21][22], india [23,24], iran [25][26][27], Kenya [28], lebanon [29], Madagascar [30,31], Malaysia [32][33][34], Pakistan [35], Peru [36], Philippines [37,38], south africa [39][40][41][42], thailand [43,44], turkey [45], Uganda [46,47], Ukraine [48], Vietnam [49,50], Zambia [51], Zimbabwe [52]. studies from multiple countries: africa [53], (Cambodia, nepal, independent republic of somaliland) [54], (Pakistan, Morocco, nigeria and Malaysia) [56], (south arica, botswana, Malawi) [55] type of study Qualitative [13,21,22,25,27,33,39,42,47,51,55], mixed methods [14,19,40,41,44,45,49,52], cross-sectional [15][16][17]20 [15][16][17]19,20,22,25,27,28,30,33,36,41,47,49,50], Clinic-based [13,14,16,25,28,37,[39][40][41]46,54], iCU [19,21,22,29,45,49,52], home-based [15,24,41,51], community-based rehabilitation [23,42,43], University-based [46], mobile rehabilitation unit [18] type of service providers [15][16][17]19,20,23,29], mobilisation & strengthening [28,39,43,45,52], assistive devices [13,28,40,44,51,53], prevention, early identification & screening [16,23,37,42,55], surgery [15,16,19], home-based rehabilitation [15,24,27], pulmonary rehabilitation [15], geriatrics [15], burns [47] (n = 1, 2.2%). Personnel providing physical rehabilitation mentioned in the studies were physiotherapists (n = 28, 63.6%), physicians (n = 20, 45.4%), nurses (n = 17, 38.6%), occupational therapists (OTs) (n = 12, 27.2%), prosthetists and orthotists (n = 9, 20.4%), speech and language pathologists (n = 9, 20.4%), mental health care providers (n = 5, 11.3%), therapists (n = 4, 9%), medical practitioners (n = 5, 11.3%), village health volunteers or community health care workers (n = 5, 11.3%), social workers (n = 3, 6.8%), exercise specialists (n = 2, 4.5%), dieticians (n = 3, 6.8%), and audiologists (n = 2, 4.5%). ...
... Gushken et al. (2020), describe the co-participation of the patient, physician and rehabilitation team in their care pathway empowered patients, and improved streamlining of their enrolment into rehabilitation [15]. Multidisciplinary care teams delivered rehabilitation care plans for patients undergoing cardiac rehabilitation [23] and post-stroke care in Malaysia [33], people with physical disability in South Africa [41], and critically ill patients in ICU in Vietnam [49] and Zimbabwe [52]. ...
Purpose:
Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs).
Materials and methods:
We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework.
Results:
Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited.
Conclusion:
The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.
... Six studies used a quantitative methodology, eight used a qualitative methodology, one used a mixed methods approach, and one used a case study design. The focus of individual studies varied but included understanding barriers to and efficiencies of discharge (New 2015;Redfern et al. 2016), evaluation and feasibility of discharge-related interventions and services Chu et al. 2020), evaluating health and disability funding timeframes (Houston et al. 2020), understanding the hospital-to-home transition (Biester et al. 2016;Conti et al. 2016;Hodson et al. 2016;Abrahamson et al. 2017;Dwyer and Mulligan 2017;Fitts et al. 2019;Irgens et al. 2020;Hersh and Armstrong 2021), evaluating discharge documentation (Kable et al. 2018), evaluation of a transitional care model from hospital to the community (Qian et al. 2019), and development of an integrated care pathway for people recovering from stroke (Abdul Aziz et al. 2017). ...
... Abdul Aziz et al. (2017) To design and obtain consensus an intersectional primary-care-led care pathway to manage stroke patients residing at home in the community was designed by a panel of expert stroke care providers N = 23; expert panel group 1 (n = 8); consultant neurologists (n = 3), family medicine specialists (n = 5); expert panel group 2 (n = 15); family medicine consultants (n = 2), rehabilitation physicians (n = 2), occupational therapists (n = 2), speech and language pathologists (n = 4), nurses (n = 3), Malaysia ...
... A focus group of specialised stroke care providers and academics recommended a specific pathway for younger people with stroke to identify the type of supports required by the person, liaise with necessary services and deliver essential information to such services during transfers of care (Abdul Aziz et al. 2017). ...
... (27) Stroke patients found it hard to reestablish their roles in society and were grieving over loss of role (28). Supportive family members play a role in enhanced health perception and positive mental wellbeing (27) A study from Malaysia has chalked out an integrated program to improve post stroke care in the community emphasizing the biological and psychosocial management which includes an early screening for depression (29) In India, a gap in providing physical and psychosocial care has been noted. A study from Southern part of India (11) reported that among stroke survivors, 70.9% had nancial needs, followed by physical (63.6%) and psychological needs (52.4%). ...
Background
Stroke causes permanent neurological damage and disability. Depending on the severity and type, stroke can leave a person with residual impairment of physical, psychological and social functions. A recurrent stroke can be avoided through integrated and well-coordinated home care which is possible only if stroke survivors perceived needs and problems are identified. This study is designed to describe the biopsychosocial problems of stroke survivors
Methods
The study used an interpretive qualitative approach by conducting in-depth interviews with 10 stroke survivors who had experienced post stroke deficits within one to three years of stroke. Participants were recruited from an outpatient clinic to gain insights into their biopsychosocial issues. Data were analyzed using Diekelmann's hermeneutical approach to uncover themes.
Results
Stroke is a sudden, stressful occurrence that affects the victim as well as their family. Disease affects physical, psychological, and socioeconomic domain. Themes emerged were categorised into these three areas. Subthemes in physical domain included difficulty with movement, nutrition, elimination, rest and sleep and activities of daily living. Subthemes in psychological domain included emotional, behavioural and cognitive reaction. Social and economic factors formed the subtheme of sociecomonic problem theme.
Conclusion
Recognising the problems patients experience while undergoing home care is essential in planning rehabilitative services for stroke victims. It can guide policies and mobilise resources to provide organised home care and prevent hospital readmissions.
... Recent domestic and international studies have shown that the use of time tracking sheets for quality control and regular retrospective summary meetings are beneficial to optimize the process. Domestic and international scholars have proposed the concept of time goal management (Audebert et al., 2006;Abdul Aziz et al., 2017). As an example, a hospital was adopted a stroke timer strategy to greatly reduce the time from admission to CT and door to needle time (DNT). ...
... Additionally, stroke care can be personalized to individual patients, potentially improving treatment outcomes and reducing the risk of complications through using precision medicine approaches. Furthermore, virtual reality technology is able to create immersive environments that simulate real-life scenarios, offering stroke patients with opportunities for rehabilitation and cognitive training (Audebert et al., 2006;Abdul Aziz et al., 2017;Ryan et al., 2017). ...
Stroke is accounted as the second-most mortality and adult disability factor in worldwide, while causes the bleeding promptly and lifetime consequences. The employed functional recovery after stroke is highly variable, allowing to deliver proper interventions to the right stroke patient at a specific time. Accordingly, the multidisciplinary nursing team, and the administrated drugs are major key-building-blocks to enhance stroke treatment efficiency. Regarding the healthcare team, adequate continuum of care have been declared as an integral part of the treatment process from the pre-hospital, in-hospital, to acute post-discharge phases. As a curative perspective, drugs administration is also vital in surviving at the early step and reducing the probability of disabilities in later. In this regard, nanotechnology-based medicinal strategy is exorbitantly burgeoning. In this review, we have highlighted the effectiveness of current clinical care considered by nursing teams to treat stroke. Also, the advancement of drugs through synthesis of miniaturized nanodrug formations relating stroke treatment is remarked. Finally, the remained challenges toward standardizing the healthcare team and minimizing the nanodrugs downsides are discussed. The findings ensure that future works on normalizing the healthcare nursing teams integrated with artificial intelligence technology, as well as advancing the operative nanodrugs can provide value-based stroke cares.
... It minimizes the care and financial support needed, leading to associated benefits for both the individual and society. It can also help to avoid costly hospitalizations and re-admissions [10][11][12]. The extent to which rehabilitation is timely and delivered along a continuum with effective referral practices, as seen in PHC, is considered an indicator of rehabilitation quality [13]. ...
Purpose
This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC).
Materials and methods
PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis.
Results
Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC.
Conclusion
Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists’ time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.
... Apart from its major impact on patients' lives, strokerelated global costs (including longterm care and productivity loss) are estimated at 810 billion euro per year [4], a number that is expected to increase significantly due to population ageing [6]. Additionally, limited intersectoral collaboration further complicates the organization and delivery of integrated care [7]. ...
Background:
To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care.
Methods:
Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands.
Results:
Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes.
Conclusions:
Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided.
... Ugotovljeno je bilo, da komuniciranje in razumevanje vlog članov tima statistično značilno prispevata k delovanju multidisciplinarnega tima za obravnavo pacientov po možganski kapi(Cramm & Nieboer, 2011). Različni avtorji(Kreps, 2016;Abdul Aziz et al., 2017;Everink, van Haastregt, Maessen, Schols & Kempen, 2017) tudi ugotavljajo, da je za uspešno obravnavo pacienta ključno aktivno in kompetentno sodelovanje zdravstvenega delavca v multidisciplinarnih timih, kjer posameznik prispeva specializirana znanja in veščine za reševanje zapletenih zdravstvenih izzivov, razvija strategije timskega komuniciranja s spodbujanjem sodelovanja med člani tima, z izmenjavo ustreznih informacij in usklajevanjem pri sprejemanju ustreznih zdravstvenih odločitev. Za uspešno timsko komuniciranje je pomembna odzivnost, poslušanje, sprejemanje in posredovanje informacij vseh članov tima(Dieleman, Farris, Feeny, Johnson & Tsuyuki, 2004). ...
Introduction: In Slovenia, routine first newborn care includes neonatal eye prophylaxis, vitamin K administration and umbilical cord protection. Vitamin K administration and neonatal eye prophylaxis are legally mandated and compulsory in Slovenia. The aim of the study was to investigate certain aspects of neonatal prophylaxis in Slovenian maternity hospitals. Methods: The descriptive and cavsal-non-experimental method of empirical research used was an online survey based on a questionnaire. The survey was carried out on a purposive sample of midwives working in Slovenian maternity hospitals. It was carried out by third-year students of the Midwifery programme at the Faculty of Health at the University of Ljubljana. The data were analysed on the basis of descriptive statistics with calculations of frequencies and percentages. Results: The results showed that most midwives use potassium hypermanganate (72 %) for prophylactic umbilical protection. Most (40 %) midwives apply vitamin K up to 1 hour after delivery. Most midwives (78 %) use information on the use of prophylactic vitamin K application, including 83 % of midwives knowing at least three benefits of prophylactic eye protection. Discussion and conclusion: The results of the survey showed that the practice of prophylactic protection in Slovenian maternity hospitals is in line with the recommendations of the profession, although it could be further optimised.
... Ugotovljeno je bilo, da komuniciranje in razumevanje vlog članov tima statistično značilno prispevata k delovanju multidisciplinarnega tima za obravnavo pacientov po možganski kapi(Cramm & Nieboer, 2011). Različni avtorji(Kreps, 2016;Abdul Aziz et al., 2017;Everink, van Haastregt, Maessen, Schols & Kempen, 2017) tudi ugotavljajo, da je za uspešno obravnavo pacienta ključno aktivno in kompetentno sodelovanje zdravstvenega delavca v multidisciplinarnih timih, kjer posameznik prispeva specializirana znanja in veščine za reševanje zapletenih zdravstvenih izzivov, razvija strategije timskega komuniciranja s spodbujanjem sodelovanja med člani tima, z izmenjavo ustreznih informacij in usklajevanjem pri sprejemanju ustreznih zdravstvenih odločitev. Za uspešno timsko komuniciranje je pomembna odzivnost, poslušanje, sprejemanje in posredovanje informacij vseh članov tima(Dieleman, Farris, Feeny, Johnson & Tsuyuki, 2004). ...
Introduction: The European Centre for Disease Prevention and Control (ECDC) ranks surgical wound infection among the most common hospital infections, which, as a result, can prolong the hospitalization time, requires additional surgical interventions, treatments and intensive therapy, or even increases mortality. Implementation of epidemiological monitoring reduces the incidence rate of surgical wound infections, and monitoring the incidence rate enables assessment of the quality of medical care. After increasing importance of verification levels of quality of medical care, the University Clinical Centre Department of Paediatric Surgery decided for the project of systematic prospective monitoring of surgical wound infections in children. Methods: A quantitative research method was used with a prospective and retrospective data analysis for certain interventions. The research project was divided into several phases. The research sample included children at the Department of Paediatric Surgery for planned and emergency surgical interventions. The children were monitored for 30 days after the intervention (in the case of an implant for 90 days). The goal of the research was to establish clinical practice of monitoring surgical wound infections in children, and the introduction of appropriate preventive measures for reducing the incidence of surgical wound infections. Results: In two months, 74 surgical interventions were analysed. Analyse showed a 4.05 % incidence of surgical wound infection. In all cases it was superficial incisional surgical wound infection. Discussion: Prevention of surgical wound infections is becoming an important part of the national health strategies in many developed countries. Expert knowledge teaches us, that a significant part of healthcare-related infections can be prevented, often by following simple rules. With the project of prospective monitoring of surgical wound infection, we first of all want to define the incidence of surgical wound infection after various surgical interventions in children, to recognize risk factors for the occurrence of surgical wound infection and introduce appropriate preventive measures to reduce the incidence of surgical wound infection.
