CLINICAL STAFF PERSPECTIVE OF POST-DISCHARGE STROKE CARE IN NORTH-WEST INDIA

Abstract

Background: As one of the most common non-communicable diseases in India, stroke results in significant residual disability and high mortality rates. 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 from Christian Medical College and Hospital, Ludhiana (CMCL) between July 2021 and January 2022. As a tertiary-level teaching hospital, CMCL serves a diverse patient population. The research team conducted interviews, before translating, transcribing, and thematically analysing data (using NVivo software).
Results: Ten participants (3 nurses, 2 neurologists, 2 physiotherapists, 2 occupational therapists, and 1 dietician) indicated the multi-disciplinary stroke team enabled individualised comprehensive post discharge plan. Patient/caregiver training and education is provided during hospitalisation and continues through follow-up, with verbal/written information supported by videos or leaflets in Hindi, Punjabi, and English. Adherence to prescribed medication, diet, rehabilitation, and follow-up visits
were impacted by challenges in patient literacy, stroke awareness, financial resources, or post discharge care. Community stroke care was provided through tele-stroke services, home-based physiotherapists, and community health workers.
We identified four themes: Integrated Inpatient Discharge Care Planning; Patient and Caregiver Engagement; Post discharge Care and Support; and Working with Challenges.
Conclusion: Key components of CMCL stroke services include treatment by a multi-disciplinary stroke care team, individualised post-discharge plan, patient-caregiver training and education, and postdischarge community care and tele-stroke services. Post-discharge care weighs heavily on family/caregivers facing various challenges (literacy, finances, local language education and availability).