Stroke survivors the 'poor relatives' of health - Portugal

This is where YOU need to get involved and demand recovery and results; NOT THIS CRAPOLA OF 'ACCESS'! 

'Access' is useless unless you have EXACT REHAB PROTOCOLS!

Stroke survivors the 'poor relatives' of health - Portugal

The Portugal AVC association has defended a strategy for the rehabilitation of stroke survivors, an area that remains the “poor relative” of the health system.

By TPN/Lusa, in News, Portugal, Health · 1 day ago · 0 Comments

 "What is missing is exactly - and as the recommendation to the Government that was approved in the Assembly of the Republic said more than a year ago - to define and implement a strategy for access to rehabilitation for all" those who have suffered a stroke, said the president of the association created in 2016.

António Conceição said that this will be one of the topics being debated in parliament, in a session regarding the National Day of the Stroke Patient, which is marked on March 31, and which aims to contribute to greater political and media visibility on the main cause of death and disability in Portugal.

In November 2021, parliament unanimously approved a resolution recommending the Government to develop, within three months, a strategy for access to rehabilitation care “effective, multidisciplinary and nationwide for survivors” of stroke.

The resolution also asked the executive to reinforce the rehabilitation teams in all hospital and extra-hospital centres, by hiring rehabilitation professionals, for the complete constitution of multidisciplinary teams.

“Glaring disparities”

 About 15 months after its publication in Diário da República, “this is a question we are going to ask. What has been done and is being done to define this strategy for rehabilitation?”, said António Conceição, for whom the “current state of things is the same or worse than it was at the time”.

According to the president of Portugal AVC - União de Sobreviventes, Familias e Amigos, the country presents a “dramatic panorama” in terms of rehabilitation care for those who survive a stroke, with “glaring disparities”.

“It is dramatic because there is a lack of responses from the National Health Service, but not only that. First of all, this rehabilitation has to be seen as multidisciplinary and timely(But it mainly needs to be effective!). Each stroke has very different consequences from person to person”, said António Conceição.

According to the president of the association, rehabilitation care therefore has to cover areas such as physiotherapy, speech and occupational therapy, nursing, psychology and nutrition, among others.

In most cases, rehabilitation is the responsibility of private and social entities, “where the quality offered – and which in general is just physiotherapy – leaves much to be desired”, warned the head of AVC Portugal, noting that “there is no control over the quality” of this care.(You don't want 'care', you want RECOVERY AND RESULTS!)

In addition to reinforcing the number of health professionals for the various areas, greater control of the quality of rehabilitation available in Portugal is necessary, to minimise the “huge inequalities that are practiced” depending on the hospital unit in which the patient is treated , geographic location, economic capacity, among other factors

António Conceição also added that the latest figures provided by the Directorate-General for Health, referring to 2016, pointed to around 25,000 cases per year in Portugal and that, according to INE data for 2020, strokes remained the main cause of death, even ahead of Covid-19.

Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

What is your hospital doing to prevent these avoidable readmissions? ARE THEY EVEN MEASURING READMISSIONS? The answer tells you the competence of the board of directors and whether they should be fired.

Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

Pedro Abreu^1,2*, Rui Magalhães³, Diana Baptista², Elsa Azevedo^1,2, Maria Carolina Silva³ and Manuel Correia^3,4

• ¹Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
• ²Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
• ³Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
• ⁴Department of Neurology, Hospital Santo António—Centro Hospitalar Universitário Do Porto, Porto, Portugal

Background: After a first-ever-in-a-lifetime stroke (FELS), hospital readmissions are common and associated with increased mortality and morbidity of stroke survivors, thus, raising the overall health burden of stroke. Population-based stroke studies on hospital readmissions are scarce despite it being an important healthcare service quality indicator. We evaluated unplanned readmissions or death during the first year after a FELS and their potential factors, based on a Portuguese community register.

Methods: Data were retrieved from a population-based prospective register undertaken in Northern Portugal (ACIN2) in 2009–2011. Retrospective information about unplanned hospital readmissions and case fatality within 1 year after FELS index hospitalization (FELS-IH) was evaluated. Readmission/death-free survival 1 year after discharge was estimated using the Kaplan–Meyer method. Independent risk factors for readmission/death were identified using Cox proportional hazard models.

Results: Unplanned readmission/death within 1 year occurred in 120 (31.6%) of the 389 hospitalized FELS survivors. In 31.2% and 33.5% of the cases, it occurred after ischemic stroke or intracerebral hemorrhage, respectively. Infections and cerebrovascular and cardiovascular diseases were the main causes of readmission. Of the readmissions, 65.3% and 52.5% were potentially avoidable or stroke related, respectively. The main cause of potentially avoidable readmissions was the continuation/recurrence of the event responsible for the initial admission or a closely related condition (71.2%). Male sex, age, previous and post-stroke functional status, and FELS-IH length of stay were independent factors of readmission/death within 1 year.

Conclusions: Almost one-third of FELS survivors were readmitted/dead 1 year after their FELS-IH. This outcome persisted after the first months after stroke hospitalization in all stroke subtypes. More than half of readmissions were considered potentially avoidable or stroke related.

Introduction

After a first-ever-in-a-lifetime stroke (FELS) or transient ischemic attack (TIA), the use of hospital emergency services or hospital readmissions is common and associated with increased stroke mortality and morbidity, thus, raising the overall health burden of stroke (1). Also, despite some well-characterized limitations (2), readmissions are currently a measure of the hospital's performance and quality of care (3).

Several risk factors for stroke readmissions have been described. However, many meaningful clinical associations may have been ignored since most studies only rely on large administrative or single-hospital databases, particular subtypes of stroke, or readmissions in the first 3 months after stroke (1, 4, 5). This assertion is especially true in Portugal, where, to our knowledge, there are no population-based stroke readmission studies, and therefore, the corresponding information is scarce.

We aimed to study unplanned readmissions or death during the first year after a FELS and to identify their potential factors, based on a Portuguese community register.

disability card use in Portugal

I only used that excuse a couple of times in the airport flying out of Lisbon. I do use it every time I fly to get on the aircraft early when they ask for pregnant, people with children and disabled. I'm sure I get stares since I don't look disabled until they see my stroke walk.

Theoretical Basis Underlying Physiotherapy Practice in Stroke Rehabilitation - Portugal

You can see from this that total incompetence reigns in stroke rehab. NO protocols, NO standards, NO measurements, NO efficacy rating, and they refer to Bobath.  Only 1 page.

Theoretical Basis Underlying Physiotherapy Practice in Stroke Rehabilitation - Portugal