Profile and outcome of post stroke patients managed at selected public primary care health centres in Peninsular Malaysia: A retrospective observational study

Affiliations


Abstract

Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.

Conflict of interest statement

The authors declare no competing interests.


Figures


Similar articles

The adaptation and validation of the satisfaction with stroke care questionnaire (Homesat) (SASC10-My™) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community.

Abdul Aziz AF, Tan CE, Ali MF, Aljunid SM.Health Qual Life Outcomes. 2020 Jun 20;18(1):193. doi: 10.1186/s12955-020-01450-9.PMID: 32563246 Free PMC article.

The integrated care pathway for managing post stroke patients (iCaPPS©) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis.

Abdul Aziz AF, Mohd Nordin NA, Muhd Nur A, Sulong S, Aljunid SM.BMC Geriatr. 2020 Feb 18;20(1):70. doi: 10.1186/s12877-020-1453-z.PMID: 32070291 Free PMC article.

Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists.

Abdul Aziz AF, Mohd Nordin NA, Abd Aziz N, Abdullah S, Sulong S, Aljunid SM.BMC Fam Pract. 2014 Mar 2;15:40. doi: 10.1186/1471-2296-15-40.PMID: 24580779 Free PMC article.

Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].

LeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA.Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1.PMID: 30354042 Free Books & Documents. Review.

Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].

Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP.Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Dec. Report No.: 13-05194-EF-1.PMID: 25632496 Free Books & Documents. Review.


Cited by

Zebrafish ambra1b knockout reveals a novel role for Ambra1 in primordial germ cells survival, sex differentiation and reproduction.

Fontana CM, Terrin F, Facchinello N, Meneghetti G, Dinarello A, Gambarotto L, Zuccarotto A, Caichiolo M, Brocca G, Verin R, Nazio F, Carnevali O, Cecconi F, Bonaldo P, Dalla Valle L.Biol Res. 2023 Apr 28;56(1):19. doi: 10.1186/s40659-023-00430-9.PMID: 37106439 Free PMC article.

Exploring the Need for Mobile Application in Stroke Management by Informal Caregivers: A Qualitative Study.

Haji Mukhti MI, Ibrahim MI, Tengku Ismail TA, Nadal IP, Kamalakannan S, Kinra S, Abdullah JM, Musa KI.Int J Environ Res Public Health. 2022 Oct 10;19(19):12959. doi: 10.3390/ijerph191912959.PMID: 36232257 Free PMC article.

Distinctive Gut Microbiota Alteration Is Associated with Poststroke Functional Recovery: Results from a Prospective Cohort Study.

Dang Y, Zhang X, Zheng Y, Yu B, Pan D, Jiang X, Yan C, Yu Q, Lu X.Neural Plast. 2021 Dec 7;2021:1469339. doi: 10.1155/2021/1469339. eCollection 2021.PMID: 34917142 Free PMC article.

Exploring Stroke Rehabilitation in Malaysia: Are Robots Better than Humans for Stroke Recuperation?

Nik Ramli NN, Asokan A, Mayakrishnan D, Annamalai H.Malays J Med Sci. 2021 Aug;28(4):14-23. doi: 10.21315/mjms2021.28.4.3. Epub 2021 Aug 26.PMID: 34512127 Free PMC article. Review.

The adaptation and validation of the satisfaction with stroke care questionnaire (Homesat) (SASC10-My™) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community.

Abdul Aziz AF, Tan CE, Ali MF, Aljunid SM.Health Qual Life Outcomes. 2020 Jun 20;18(1):193. doi: 10.1186/s12955-020-01450-9.PMID: 32563246 Free PMC article.


KMEL References


References

  1.  
    1. Kumar S, Selim MH, Caplan LR. Medical complications after stroke. The Lancet Neurol. 2010;9(1):105–18. - PubMed
  2.  
    1. Wissel J, Olver J, Sunnerhagen KS. Navigating the Poststroke Continuum of Care. J Stroke Cerebrovasc Dis. 2011;22(1):1–8. - PubMed
  3.  
    1. Wasay M, Khatri I, Kaul S. Stroke in South Asian countries. Nat Rev Neurol. 2014;10(3):135–143. - PubMed
  4.  
    1. Cameron JI, Tsoi C, Marsella A. Optimizing stroke systems of care by enhancing transitions across care environments. Stroke. 2008;39(9):2637–2643. - PubMed
  5.  
    1. Brainin M, et al. Poststroke chronic disease management: Towards improved identification and interventions for poststroke spasticity-related complications. Int J Stroke. 2011;26(1):42–46. - PubMed
  6.  
    1. Broomhead D., Green P., Lockhart J. & Walker T. Stroke rehabilitation in the community: commissioning for improvement. An information resource for providers and comissioners of stroke rehabilitation and early supported discharge services in the community. NHS Outcomes Framework 2012–2013. Department of Health. UK (2011).
  7.  
    1. Philp I, et al. Development of a poststroke checklist to standardize follow-up care for stroke survivors. J Stroke Cerebrovasc Dis. 2013;22(7):e173–180. - PubMed
  8.  
    1. Langhorne P, de Villiers L, Pandian JD. Applicability of stroke-unit care to low-income and middle-income countries. The Lancet Neurology. 2012;11(4):341–348. - PubMed
  9.  
    1. Scholte op Reimer WJM, et al. Quality of hospital and outpatient care after stroke or transient ischemic attack: insights from a stroke survey in the Netherlands. Stroke. 2006;37(7):1844–1849. - PubMed
  10.  
    1. Abdul Aziz AF, et al. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic. J Neurosci Rural Pract. 2013;4(4):413–20. - PMC - PubMed
  11.  
    1. Hamidon BB, Raymond AA. Risk factors and complications of acute ischaemic stroke at Hospital Universiti Kebangsaan Malaysia (HUKM) Med J Malaysia. 2003;58(4):499–505. - PubMed
  12.  
    1. Abdul Aziz AF, et al. Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists. BMC Fam Pract. 2014;15(1):40. - PMC - PubMed
  13.  
    1. Geddes J, Chamberlain M. Home-based rehabilitation for people with stroke: a comparative study of six community services providing co-ordinated, multidisciplinary treatment. Clin Rehabil. 2001;15:589–99. - PubMed
  14.  
    1. Mohan KM, et al. Risk and cumulative risk of stroke recurrence: A systematic review and meta-analysis. Stroke. 2011;42(5):1489–1494. - PubMed
  15.  
    1. Venketasubramanian N, et al. Bridging the Gap Between Primary and Specialist Care-An integrative model for stroke. Ann Acad Med Singapore. 2008;37(2):118–127. - PubMed
  16.  
    1. Choi YK, Han JH, Li R, Kung K, Lam A. Implementation of secondary stroke prevention protocol for ischaemic stroke patients in primary care. Hong Kong Med J. 2015;21(2):136–142. - PubMed
  17.  
    1. Mitchell GK, Brown RM, Erikssen L, Tieman JJ. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review. BMC Fam Pract. 2008;9:44. - PMC - PubMed
  18.  
    1. Joubert J, et al. Stroke in rural areas and small communities. Stroke. 2008;39(6):1920–1928. - PubMed
  19.  
    1. Joubert J, et al. Integrated care improves risk-factor modification after stroke: initial results of the Integrated Care for the Reduction of Secondary Stroke model. J Neurol Neurosurg Psychiatry. 2009;80(3):279–84. - PubMed
  20.  
    1. Mohd Nordin NA, et al. Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions. BMC Health Serv Res. 2014;14:118. - PMC - PubMed
  21.  
    1. Kamal RM, Ward E, Cornwell P. Levels of Awareness, Involvement and Training in Dysphagia Management Among Other Health Professionals in Malaysia. Dysphagieforum. 2013;1:4–15.
  22.  
    1. Hankey GJ, et al. Long-Term Risk of First Recurrent Stroke in the Perth. Stroke. 1998;29:2491–500. - PubMed
  23.  
    1. Tilling K, et al. A new method for predicting recovery after stroke. Stroke. 2001;32(12):2867–73. - PubMed
  24.  
    1. Fens M, et al. Multidisciplinary care for stroke patients living in the community: A systematic review. J Rehabil Med. 2013;45(4):321–330. - PubMed
  25.  
    1. Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke. 2013;8(1):38–45. - PubMed
  26.  
    1. Talbot LR, et al. Identification of rehabilitation needs after a stroke: an exploratory study. Health Qual Life Outcomes. 2004;2:53. - PMC - PubMed
  27.  
    1. Malaysian Society of Neurosciences, Academy of Medicine Malaysia M of HM. Management of Ischaemic Stroke- Clinical Practice Guidelines [Internet]. 2012 [cited 2013 Mar 30]. Available from, http://www.acadmed.org.my/index.cfm?&menuid=67.
  28.  
    1. Ministry of Health Malaysia; Academy of Medicine of Malaysia; Malaysian Society of Hypertension. Clinical Practice Guidelines: Management of Hypertension for Healthcare Providers 1–8 (2008)
  29.  
    1. Malaysian Endocrine & Metabolic Society, Ministry of Health Malaysia Academy of Medicine Malaysia & Perstauan Diabetis Malaysia. Management of Type 2 Diabetes Mellitus2015, 1–129 (2009).
  30.  
    1. Burn J, et al. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke. 1994;25(2):333–337. - PubMed
  31.  
    1. Mohan KM, et al. Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2009;80(9):1012–1018. - PubMed
  32.  
    1. Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C. Ten-year survival after first-ever stroke in the Perth Community Stroke Study. Stroke. 2003;34(8):1842–1846. - PubMed
  33.  
    1. Sun Y, Lee SH, Heng BH, Chin VS. 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore. BMC Neurol. 2013;13(1):133. - PMC - PubMed
  34.  
    1. Duncan PW, et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke. 2005;36(9):e100–143. - PubMed
  35.  
    1. Smith LN, et al. Rehabilitation of patients with stroke: summary of SIGN guidance. BMJ. 2010;340(2):c2845–c2845. - PubMed
  36.  
    1. Australian National Stroke Foundation. Clinical Guidelines for Stroke Management 2010.
  37.  
    1. Hebert R, Durand PJ, Dubuc N, Tourigny A, Group P. PRISMA: a new model of integrated service delivery for the frail older people in Canada. Int J Integr Care. 2003;3:e08. - PMC - PubMed
  38.  
    1. Béland F, Hollander MJ. Integrated models of care delivery for the frail elderly: International perspectives. Gac Sanit. 2011;25(SUPPL. 2):138–146. - PubMed
  39.  
    1. Brainin M, Teuschl Y, Kalra L. Acute treatment and long-term management of stroke in developing countries. The Lancet Neurol. 2007;6(June):553–561. - PubMed
  40.  
    1. Fisher RJ, et al. A consensus on stroke: early supported discharge. Stroke. 2011;42(5):1392–1397. - PubMed
  41.  
    1. McMahon GM, et al. The association between vitamin B12, albuminuria and reduced kidney function: an observational cohort study. BMC Nephrol. 2015;16:7. - PMC - PubMed
  42.  
    1. Wu C, Tsai C, Kor C, Tarng D. Stroke and Risks of Development and Progression of Kidney Diseases and End- Stage Renal Disease: A Nationwide Population-Based Cohort Study. PLoS One. 2016;11(6):1–15. - PMC - PubMed