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

Abstract

Background: As one of the most common non-communicable diseases in India, stroke results in significant residual disability and a high mortality rate. Stroke care in India is often fragmented, exacerbated by a lack of public resources, information, and awareness. Stroke 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
improving outcomes. This study explores key components and challenges of post-discharge stroke services with clinical staff.
Methods: We undertook ten semi-structured qualitative interviews with a purposive sample from health professionals, representing the multidisciplinary stroke teams from Indira Gandhi Medical College and Hospital, Shimla, (IGMC) from October to December 2021. As a tertiary-level teaching hospital, IGMC serves a diverse patient population and demography. The research team conducted interviews, before translating, transcribing, and thematically analysing data (using NVivo software).
Results: Ten health professionals (4 doctors, 2 nurses, 1 physiotherapist, 1 speech and language therapist, 1 medical social worker, and 1 psychiatrist) indicated the multi-disciplinary stroke team enabled individualized comprehensive post-discharge plan. Healthcare professionals identified the need for improved post-discharge community support (psychological, speech, and physical rehabilitation) and patient transportation. Limited staff often resulted in task-shifting and innovative use of tele-support due to geographical challenges. Long-term caregiver support is affected by availability, literacy, and finances.
Four themes were identified: Integrated Inpatient Discharge Care Planning; Patient and Caregiver Engagement; Post discharge Care and Support; and Working with Challenges.
Conclusion: Post-discharge care is a key component in the recovery of stroke patients which can be improved by integrated post-discharge services. However, gaps exist in the discharge planning, resources, and services available for post-discharge support. Patient/caregiver demographic characteristics (age, geographic area, family structure, and socioeconomic status) are both barriers and facilitators to post-discharge care.