THE UPTAKE AND COSTS OF GUIDELINES FOR STROKE IN A DISTRICT OF SOUTHERN ENGLAND

Study objective-To assess the impact of guidelines for stroke manageme nt on the utilisation of services by patients and the cost consequence s of implementation. Design-Prospective audit. Setting-District health authority in southern England Patients-A total of 468 live non-comato se stroke patients registered between November 1991 and May 1993. Main outcome measures-A comparison between the three, six month periods fo r investigations performed and rehabilitation received and their assoc iated costs.Results-The appropriateness of the use of investigations i mproved over time to between 88 and 92% except for computed tomography (CT) (24%). Younger, more severely impaired patients in a medical bed were more likely to have CT. Overall levels of rehabilitation were lo w. There was no change in use of physiotherapy (61% to 63%), a signifi cant increase in occupational therapy (26% to 39%) and a non significa nt change in speech therapy (34% to 25%) over time. Guideline introduc tion caused a modest pound 23 increase in costs per patient in the 2nd six months and pound 41 in the 3rd six months but this sum could rise to pound 430 per patient if full implementation of the guidelines occ urred which is still only around 13% of the costs of nursing care whil e in hospital. Conclusions-This 18 month audit shows only modest chang es in practice compared with guidelines, and overall levels of rehabil itation were low. The costs of full implementation seem considerable, but in fact constitute only a small proportion of nursing care costs.