EXPERIENCE OF AN OPEN REFERRAL SYSTEM FOR STROKE REHABILITATION IN THE COMMUNITY

Objective: To examine referral patterns and characteristics of patient s assessed by a community stroke rehabilitation service utilizing an o pen referral system. Design: Descriptive study. Setting: Two boroughs in a health district in South London, England. Subjects: Two hundred a nd seventy-six patients with stroke assessed by the service in its fir st 18 months of operation. Results: Patients were referred from a vari ety of sources including hospitals (38%), general practitioners (18%), district nurses (10%), social services (9%), self-referrals (8%), com munity physiotherapists (7%) and family or carers (2%). Referrals from hospital were younger (33% aged under 65 years) while referrals from community health and social services were older (44% aged 75-84 years) (chi(2) = 23, df = 9, p < 0.01). Fifty per cent of patients who had s elf-referred or had been referred by families or carers had longstandi ng stroke (> 1 year), 46% of patients from general practitioners had a cute stroke (< 4 weeks) and 37% of hospital patients were seen between one and three months post stroke (chi(2) = 50.4, df = 12, p < 0.001). There was a marginally significant difference in the prevalence of in continence and no significant differences in limb weakness, visual imp airment and speech impairment. There were no significant changes in so urces of referral between the first and second nine months of the serv ice. There was a significant increase in the percentage of patients wi th recent stroke seen in the second nine months (chi(2) = 22.8, df = 5 , p < 0.001). In this period, 36% of patients assessed were seen withi n four weeks of their stroke compared with 15% in the first nine month s. Of patients with stroke, 8.7% were considered to have been inapprop riate referrals but they were not significantly associated with any pa rticular source of referral. Conclusions: Referrals were received from a wide variety of sources with significant differences in age and dur ation of stroke of patients from different referral sources. The resul ts suggest that an open referral system may make rehabilitation access ible to a broader range of patients with stroke living in the communit y.