PATTERNS OF ACUTE STROKE CARE IN 3 DISTRICTS OF SOUTHERN ENGLAND

objective-To quantify the use of health care services by acutely ill s troke patients in three district health authorities. Design-A follow u p study of all patients recorded in population based registers who had a first ever stroke in three district health authorities, with assess ment following the onset and three months after the stroke. Setting-We st Lambeth, Lewisham and North Southwark, and Tunbridge Wells District Health Authorities in south east England. Subjects-All first time str oke patients under the age of 75 years who presented between 15 August 1989 and 14 August 1990. Measurements and main results-Hospital admis sion rates, rates of use of rehabilitation services, and contact with medical practitioners together with assessment of disability and handi cap were determined. A total of 386 strokes were registered. Seventy e ight per cent were treated in hospital and younger and incontinent pat ients were significantly more likely to be admitted. The median stay w as 21 days. Patients in West Lambeth, those paralysed, and those who s tayed longer in hospital were more likely to receive physiotherapy. Al together 265 patients were followed up, 117 having died within three m onths of the stroke. During the three months, 150 (57%) had seen a hos pital physician and 181 (69%) their general practitioner, but 18 (7%) had seen neither. Sixty seven (26%) patients were moderately or severe ly disabled. Twenty seven per cent of inpatients had received no inpat ient physiotherapy and 67% of all patients no outpatient physiotherapy during the three months. Conclusions-The hospital admission rates wer e high, with long lengths of stay. There were significant differences in the amount of rehabilitation received in each district. This was lo w overall, especially for those not admitted to hospital. As expected, patients admitted for long periods were the most likely to receive th erapy. Before district policies for admission and management of stroke patients can be drawn up, increased knowledge of which aspects of str oke management are effective is needed. Policies should aim to provide planned, coordinated care between hospital and the community. It is s triking that many patients received no form of rehabilitation therapy.