CLINICAL STAFF PERSPECTIVES OF POST-DISCHARGE STROKE CARE IN SOUTHERN INDIA

Abstract

Background: As one of the most common non-communicable diseases in India, stroke results in significant residual disability and high mortality. Stroke care in India is often fragmented, exacerbated by a lack of public resources, information, and awareness. Survivors experience a range of disabilities and are cared for by their families long-term. Rehabilitation combined with secondary prevention is critical to post-discharge stroke care, in reducing recurrence, mortality, and improve outcomes. This study explores key components and challenges of post-discharge stroke services with clinical staff.
Methods: We undertook ten semi-structured interviews with a purposive sample from health professionals, representing the multidisciplinary stroke teams (MDTs) from National Institute of Mental Health And Neuro Sciences, Bengaluru (NIMHANS) between September and November 2021. The research team conducted interviews, before translating, transcribing, and thematically analysing data (using NVivo). Institution ethical approval was granted, and informed consent obtained from participants.
Results: Ten participants (3 nurses, 2 occupational therapists, 1 physiotherapist, 1doctor, 1 psychiatric social worker, 1 speech pathologist/audiologist, and 1 dietician) indicated that a comprehensive MDT contributed to individualised, comprehensive post-discharge planning; however, there was no specific discharge protocol. Patient/caregiver training and education was provided during hospitalisation and continued through follow-up. Health education material was verbal or written; pamphlets/leaflets were in multiple languages including English, Kannada and Hindi. Patients/caregivers faced various challenges including stigma, financial constraints, availability of supportive family members, patient transportation from rural areas and psychological impact of stroke. Stroke care services in the community were restricted to urban populations, however rural patients that do not have adequate stroke support services could access tele-consultation services. We identified four themes: integrated Inpatient Discharge Care Planning; Patient and Caregiver Engagement; Post discharge Care and Support; and Working with Challenges.
Conclusion: Stroke care is continuous and faces multiple challenges which require multidisciplinary care and planning to improve outcomes.