A&E data demonstrates need for right to rehab

 WRONG, WRONG, WRONG! Access is not what's needed, survivors want recovery you blithering idiots. 

'Access' only gets you a 10% chance of full recovery.

Survivors want 100% recovery, or don't you ever talk to survivors without promoting your tyranny of low expectations?

A&E data demonstrates need for right to rehab

A new report into the unmet need driving accident and emergency attendance shows the shift from hospital to the community ‘must happen everywhere’, the CSP says.

25 November 2024 - 1:29PM

An audit of emergency care data by the British Red Cross found one in seven patients are repeat visitors with unmet medical needs who feel they have nowhere else to go. 

Most were over 70 with multiple conditions or under 50 with mental ill health. 

Sara Hazzard, assistant director of the CSP and co-chair of the Community Rehab Alliance, said this highlighted the need for better access to services outside of the hospital.  

‘This is a change that must happen everywhere,’ she said. 

‘One in four people are now living with at least one long-term condition and this number is forecast to rise to two-thirds within a decade. It is essential that everyone who needs it has access to high-quality rehab services close to home in their community.

‘These services keep people out of hospital and living independently at home and must be available to all. 

‘We cannot keep failing people living with long-term conditions.’ 

There is still a chance for CSP members to take part in the national consultation on the future of the NHS. 

If you want to influence the government’s priorities for staffing and funding under its NHS reforms, have your say at change.nhs.uk by 2 December.

 

National stroke report a call for action - Australia

 

WRONG, WRONG, WRONG! YOU have to inform them this is completely WRONG!  Survivors want 100% RECOVERY STANDARDS NOT PREVENTION. This is non-negotiable! Screaming may be required!

National stroke report a call for action

             With the billion-dollar impact of stroke uncovered, and rates predicted to rise, experts(WELL, YOUR EXPERTS DON'T KNOW WHAT THE FUCK IS NEEDED!) are calling for urgent investment into prevention.

One stroke occurred every 11 minutes in Australia last year, making up almost 46,000 new strokes.

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For each person who had a stroke in 2023, their lifetime cost to the economy will total $350,000, and half of that cost will be created in the first year alone.
 
That is according to a new report from the Stroke Foundation, which reveals the full impact of stroke in Australia, detailing healthcare costs as well as savings from the implementation of prevention initiatives.
 
It harnesses a call to action to address stroke and its risk factors, to prevent incidences and associated costs of stroke incidences increasing.
 
In 2023, the report found that 45,785 Australians experienced a stroke, including 34,793 for the first time and 10,992 a recurrent stroke. This translates to one stroke every 11 minutes.
 
According to new data from the Australian Bureau of Statistics, stroke was the nation’s third leading cause of death in 2023, up from fourth position the year before.
 
While stroke is often associated with older people, one in four first-ever strokes in 2023 occurred in people aged under 65 years, while one in 10 of those who experienced a recurrent stroke were in the same age bracket.
 
In partnership with Monash University, the Stroke Foundation report provides an evidence-base for healthcare organisations and governments to improve policy and investment in prevention, treatment, and recovery for survivors of stroke, their families and carers.
 
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, said the report adds weight to the RACGP’s advocacy for the health system to ‘take prevention seriously’.
 
‘This research is a salient reminder for GPs of the devastating impact of stroke on individuals,’ he told newsGP.
 
‘A good start would be to invest in patient rebates for regular comprehensive health assessments at all ages, rather than just once in middle age and every year from the age of 75.
 
‘These “birthday” health assessments would provide funding for the persons regular GP and their teams to apply all the screening, case finding and preventive recommendations from the Red Book.’
 
Currently there are an estimated 440,481 stroke survivors in Australia, made up of 244,756 males and 195,725 females.
 
Using the data on stroke incidences and expected population growth, the report estimates the number of stroke events will increase to almost 55,000 first-ever strokes and 17,000 recurrent strokes per year by 2050.
 
Stroke Foundation CEO Dr Lisa Murphy said the report shows there is ‘no time to waste’.
 
‘This projection is a worrying reality if we do not address the rising tide of modifiable stroke risk factors and improve stroke prevention for all Australians,’ she said.
 
‘The good news is, if we act now, we can ensure more Australians have better control of their blood pressure and other risk factors.’
 
Modifiable risk factors for stroke include hypertension, diabetes, high cholesterol, smoking, physical inactivity and being overweight.
 
While one in three Australian adults (6.8 million people) have hypertension – which is the number one risk factor for stroke – half (3.4 million) are unaware they have it.
 
Professor Morgan said for GPs, there are important roles to help reduce the impacts of stroke.
 
‘GPs can train their staff to appreciate the urgency of a “brain attack” to reduce delays in assessment and treatment,’ he said.
 
‘Practice Incentive Program data suggests only half of regular patients in the eligible population, now 45–79-year-olds, have recorded risk factors of diabetes status, smoking status, cholesterol, and blood pressure.
 
‘Computer decision support programs can identify people at high risk who would benefit from increased preventive treatments and monitoring.’
 
Professor Morgan added that GPs can also help to arrange ongoing rehabilitation and reducing risk factors in people who have already had a stroke.
 
Economic impacts are often ‘incurred well into the future’ due to the long-term effects of stroke, the report states, with these costs worn by the person who has the stroke, their carers, and the Government.
 
Lifetime costs for strokes that occurred in 2023 exceed $15 billion, with costs in the first year after stroke more than $7.7 billion.
 
Healthcare costs to government sit at $5.5 billion, costs related to unpaid care at $3.3 billion, and lost productivity costs $6.3 billion, which include in the workplace and at home, as well as the delivery of ‘informal care’.
 
The cost of stroke to the National Disability Insurance Scheme (NDIS) is more than $1.3 billion, or $143,000 per survivor of stroke, per year.
 
For strokes that occurred in 2023, healthcare costs included ambulance rides, short- and long-term hospital stays, and post-discharge from hospital, including medication, GP visits and other specialist services such as pathology, allied health and aged care.
 
However, the report highlights the potential cost savings that would come from initiatives to prevent stroke and ensure better recovery outcomes, including:

• $26 million through improvements in provision of acute care in line with the 30/60/90 National Stroke Targets
• $315 million by improving the rate of uncontrolled hypertension in line with the goal of the National Hypertension Taskforce’s Roadmap
• $118 million by improving access to community rehabilitation services.

Primary care chronic disease management plans have also been shown to improve long-term recovery and survival of people who have a stroke.

No time to waste in improving Australias stroke care

 WRONG, WRONG, WRONG! YOU have to inform them this is completely WRONG!  Survivors want RECOVERY STANDARDS NOT 'CARE'. This is non-negotiable! Screaming may be required!

No time to waste in improving Australias stroke care

Stroke experts(They most assuredly are NOT EXPERTS) have welcomed the publication of a journal article that calls for a united approach to the country’s lagging stroke care standards.

It comes just days after a new report revealed the number of Australians having strokes is the greatest it has been in more than two decades.

Stroke is the third most common cause of death in Australia and a leading cause of disability. Despite this, Australia is falling behind its international counterparts when it comes to receiving lifesaving treatment.

When compared to other developed countries, the time it takes for an Australian stroke patient to receive clot busting drugs (known as door-to-needle time) is significantly longer. The longer stroke is left untreated, the more brain dies, and the lower the chances of survival and recovery.  

An accepted international door-to-needle target is within 60 minutes of a patient arriving in hospital. Currently, the median Australian door-to-needle time is 75 minutes, and only 27% of patients were treated within an hour of hospital arrival, that’s compared to 82% in Sweden, 75% in the United States and 61% in the United Kingdom. 

In August 2023, the country’s leading stroke organisations agreed upon bold new targets which aimed to provide Australians with access to the same world-leading stroke care available in many other developed countries.

Australian and New Zealand Stroke Organisation President, Professor Timothy Kleinig, said door-to-needle times and stroke unit admission percentages have not improved over the past six years.

“Australian stroke patients deserve better to improve their chance of survival and reduce their risk of disability after stroke,” Professor Kleinig said.

“Every person who has a stroke in Australia should be provided, where possible, with the opportunity to access both stroke unit care and reperfusion therapies. This is particularly true for Australians living in regional and remote Australia. These targets will go a long way in helping achieve that goal.”

A recent Stroke Foundation report revealed that by delivering on the 30/60/90 National Stroke Targets, not only would there be huge benefits to survivors of stroke in receiving better treatments, but it would also save the economy $26 million.

Stroke Foundation Chief Executive Officer, Dr Lisa Murphy, said a national commitment to addressing the treatment gaps is required.

“We need all levels of the health system and government, supported by ambulance and retrieval services, emergency and radiology departments, and medical and nursing staff to commit to delivering the National Stroke Targets by 2030,” Dr Murphy said.

Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke

WRONG, WRONG, WRONG! Survivors don't care about cost, they want effectiveness. How close does this get them to 100% recovery? Are you that blitheringly stupid? 

My social enrichment/connections is live jazz music at bars, what's yours?

Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke

Cassandra Adjetey, MA^1,2; Jennifer C. Davis, PhD^1,2,3; Ryan S. Falck, PhD^3,4,5; et al John R. Best, PhD^3,4,5; Elizabeth Dao, PhD^3,4; Kim Bennett, MSc^3,4,5; Daria Tai, MPH³; Katherine McGuire, MD³; Janice J. Eng, PhD^3,4; Ging-Yuek Robin Hsiung, MD⁵; Laura E. Middleton, PhD^6,7; Peter A. Hall, PhD⁸; Min Hu, PhD⁹; Brodie M. Sakakibara, PhD^10,11; Teresa Liu-Ambrose, PhD^3,4,5

Author Affiliations Article Information

JAMA Netw Open. 2023;6(11):e2345687. doi:10.1001/jamanetworkopen.2023.45687

Key Points

Question  What is the cost-effectiveness of exercise or cognitive and social enrichment activities to improve cognition among older adults with chronic stroke?

Findings  In this economic evaluation with 120 older adults from a randomized clinical trial, the multicomponent exercise program conducted over a 6-month period was cost-effective for cognitive function, with limited impact on health-related quality of life. Cognitive and social enrichment activities incurred higher costs compared with the balance and tone control group.

Meaning  These findings suggest that multicomponent exercise may be a cost-effective approach to improving cognitive function in older adults with chronic stroke.

Abstract

Importance  Cognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain.

Objective  To conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program.

Design, Setting, and Participants  This economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, between June 6, 2014, and February 26, 2019. Participants were community-dwelling adults aged 55 years and older who experienced a stroke at least 12 months prior to study enrollment in the Vancouver metropolitan area, British Columbia, Canada. Data were analyzed from June 1, 2022, to March 31, 2023.

Interventions  Participants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control).

Main Outcomes and Measures  The primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale–Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs. Since cognitive benefits 6 months after intervention cessation were not observed in the primary randomized clinical trial, an economic evaluation at 12 months was not performed.

Results  Among 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost per mean change in Alzheimer Disease Assessment Scale–Cognitive-Plus score demonstrated that exercise was more effective and costlier compared with the control group in terms of cognitive improvement with an incremental cost-effectiveness ratio of CAD −$8823. The cost per quality-adjusted life-year gained for both interventions was negligible, with exercise less costly (mean [SD] incremental cost, CAD −$32 [$258]) and cognitive and social enrichment more costly than the control group (mean [SD] incremental cost, CAD $1018 [$378]). The balance and tone program had the lowest delivery cost (CAD $777), and the exercise group had the lowest health care resource utilization (mean [SD] $1261 [$1188]) per person.

Conclusions and Relevance  The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention.