CLINICAL STAFF PERSPECTIVES OF POST-DISCHARGE STROKE CARE IN WEST 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. 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 improve
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 (MDTs) from Zydus Hospitals and Healthcare Research Pvt. Ltd., Ahmedabad between 22 Nov 2021 to 24 Dec 2021. Zydus is a private hospital that serves a diverse patient population. The research team conducted interviews, before translating, transcribing, and thematically analysing data (using NVivo).
Results: Based on ten participants’ (3 nurses, 2 neurologists, 2 physiotherapist, 1 speech therapist, 1 dietician, 1 medical officer) responses, we identified four themes: Integrated Inpatient Discharge Care Planning; Patient and Caregiver Engagement; Post-discharge Care and Support; and Working with Challenges. Clinical staff highlighted the importance of the various roles of the MDT. A comprehensive discharge summary included the medications, patient progress, complications, follow-up appointments, rehabilitation instructions and lifestyle advice. Despite this, patients/caregivers discussed, with staff, their lack of confidence in post-discharge care and a fear of stroke reoccurrence.
Conclusion: The discharge summary provides key information on all aspects of patient care post discharge. Further referral, and advice, as required, are provided at follow-up appointments, as determined by patient’s level of need and disability. Psychological support, post-discharge, was important for patients’/caregivers’ mental health and patient recovery. Tele-support provides a mechanism for patients/caregivers to contact the medical team for advice and emergencies.