“It’s Difficult, There’s No Formula”: Qualitative Study of Stroke Related Communication Between Primary and Secondary Healthcare Professionals

Aquino, Maria Raisa Jessica; Mullis, Ricky; Moore, Caroline; Kreit, Elizabeth; Lim, Lisa; McKevitt, Christopher; Mackintosh, Bundy; Mant, Jonathan

doi:10.5334/ijic.5465

Cited by 11 publications

(10 citation statements)

References 37 publications

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“…Yet, in the UK, gaps in the wholesale integration of this approach are still evident, as care deficiencies such as: abrupt discharge, poor communication and poor follow-up endure ( 96 ). This is characterized by the continuation of inadequate communication between healthcare sectors resulting in fragmented care and unmet stroke survivor needs ( 97 ). Many of these issues were reflected in the digital stories where the participants detailed the absence of patient-centered approaches during acute hospitalization, their return home, and long-term adjustment.…”

Section: Discussionmentioning

confidence: 99%

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Hall

Kroll

Wijck

et al. 2022

Front. Rehabilit. Sci.

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BackgroundStroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals.MethodsThis study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions.FindingsSix online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support.ConclusionStroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.

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Section: Discussionmentioning

confidence: 99%

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Hall

Kroll

Wijck

et al. 2022

Front. Rehabilit. Sci.

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“…Although this study was not designed to assess the roles of primary and specialty care providers in the care of stroke survivors discharged home, it provides evidence that both levels of care are being utilized by stroke patients. Current poststroke ambulatory care is siloed, with little communication between the provider groups 25. Data from the National Health Interview Survey suggest that, although 85% of stroke survivors report having had a visit to a primary care provider within 12 months postdischarge, close to half will not have seen a neurologist during that time 26.…”

Section: Discussionmentioning

confidence: 99%

“…Current poststroke ambulatory care is siloed, with little communication between the provider groups. 25 Data from the National Health Interview Survey suggest that, although 85% of stroke survivors report having had a visit to a primary care provider within 12 months postdischarge, close to half will not have seen a neurologist during that time. 26 Importantly, federally-subsidized health insurance is available to nearly all individuals over the age of 65, but stroke survivors younger than 65 may have more limited access to physicians and medications than older stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA

et al. 2022

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Background and Objectives: We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States.Methods: Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol.Results: Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR = 1.27 (95% CI: 1.14-1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR = 1.87 (95% CI: 1.54-2.27)].Discussion: The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers.

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“…Integrated care interventions for stroke have primarily focussed on problems in the post-acute phases of care such as transitioning from the hospital to care provision in the community or primary care setting. Examples described in the literature include “silo-based” care provision, lack of integration between sectors, limited access to specialists, gaps in care transitions and discharge planning as well as insufficient patient involvement, shared decision-making and self-management support [ 15 16 17 18 19 ]. However, even within hospitals, stroke care is extremely complex and fragmentation regularly occurs at various points along the pathway.…”

Section: Introductionmentioning

confidence: 99%

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study

Busetto

Hoffmann

Stang

et al. 2022

International Journal of Integrated Care

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Introduction:Patients experiencing acute ischemic stroke should access treatment as soon as possible to increase their chances for survival without severe disability. Given the increased complexity of stroke treatment from the provider and patient perspective, this study provides an overview of the pathways followed by stroke patients during in-hospital treatment.Methods: This qualitative study combined twenty-seven observations and fifteen staff interviews at a German comprehensive stroke center providing endovascular treatment ("EVT hospital"). Analysis was based on the COMIC Model for the comprehensive evaluation of complex health care interventions and a grounded theory approach. Results:The patient pathways during in-hospital treatment span the phases (1) admission to hospital, (2) receiving recanalization therapies, and (3) in-patient treatment. Before admission to the EVT hospital, interactions between staff members from the EVT hospital and patients take place as part of the telestroke consultations during which the EVT hospital's ED neurologist meets the patient via a video-and audio-based connection. During the second phase, when IVT and/or EVT are provided to the patient, three teams (ED, neuroradiology and ICU team) with direct patient interactions intersect at the angiography suite until mechanical recanalisation treatment ends and the patient is transferred to the SU or ICU. In the third phase, the patients are treated on the SU or ICU and staff members interact with them according to a pre-defined schedule as well as based on individual needs. Discussion: Our results show that most direct staff-patient interactions are focussed within one phase, with a smaller number of interactions extending to other phases, and no professional (group) with direct patient interactions cover more than two phases of the acute stroke pathway. Future research should investigate how the pathways described here are experienced from the patient perspective, including how the organisation of visible care processes may influence patient satisfaction. Findings can be translated to accessible patient information resources as well as input for digitalisation efforts, provider orientation and training.

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“It’s Difficult, There’s No Formula”: Qualitative Study of Stroke Related Communication Between Primary and Secondary Healthcare Professionals

Cited by 11 publications

References 37 publications

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study

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