I guess India still has no fucking clue that survivors want recovery NOT 'CARE'!
MPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India
Abstract
Background:
India
accounts for 13.3% of global disability-adjusted life years (DALYs)
lost due to stroke with a relatively younger age of onset compared to
the Western population. In India’s public healthcare system, many stroke
patients seek care at tertiary-level government-funded medical colleges
where an optimal level of stroke care is expected. However, there are
no studies from India that have assessed the quality of stroke care,
including infrastructure, imaging facilities, or the availability of
stroke care units in medical colleges.
Aim:
This
study aimed to understand the existing protocols and management of
acute stroke care across 22 medical colleges in India, as part of the
baseline assessment of the ongoing IMPETUS stroke study.
Methods:
A
semi-structured quantitative pre-tested questionnaire, developed based
on review of literature and expert discussion, was mailed to 22
participating sites of the IMPETUS stroke study. The questionnaire
assessed comprehensively all components of stroke care, including human
resources, emergency system, in-hospital care, and secondary prevention.
A descriptive analysis of their status was undertaken.
Results:
In
the emergency services, limited stroke helpline numbers, 3/22 (14%);
prenotification system, 5/22 (23%); and stroke-trained physicians were
available, 6/22 (27%). One-third of hospitals did not have on-call
neurologists. Although non-contrast computed tomography (NCCT) was
always available, 39% of hospitals were not doing computed tomography
(CT) angiography and 13/22 (59%) were not doing magnetic resonance
imaging (MRI) after routine working hours. Intravenous thrombolysis was
being done in 20/22 (91%) hospitals, but 36% of hospitals did not
provide it free of cost. Endovascular therapy was available only in 6/22
(27%) hospitals. The study highlighted the scarcity of
multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22
(32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and
decompressive craniectomy, 9/22 (41%), were performed in limited
numbers. The availability of occupational therapists, speech therapists,
and cognitive rehabilitation was minimal.
Conclusion:
This
study highlighted the current status of acute stroke management in
publicly funded tertiary care hospitals. Lack of prenotification,
limited number of stroke-trained physicians and neurosurgeons,
relatively lesser provision of free thrombolytic agents, limited stroke
units, and lack of rehabilitation services are areas needing urgent
attention by policymakers and creation of sustainable education models
for uniform stroke care by medical professionals across the country.
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