Pathways show better care for patients with stroke

Stroke
occurs when the blood supply to the brain is cut off, resulting in cell
damage and death due to lack of oxygen and nutrients. Facial weakness,
arm weakness, difficulty with speech and time to call emergency services
(FAST
test) are the most common signs of stroke. A stroke can happen in two
main ways: either when a blood vessel is blocked by a blood clot or
plaque, termed ischemic stroke or when a blood vessel is ruptured, known as hemorrhagic stroke. A transient ischemic attack (TIA) or mini stroke is caused by a temporary blood clot and is indicative of a more serious risk of a future stroke.

Stroke is a major public health problem worldwide and the third leading cause of death in the United States. The incidence of stroke is high in EU  countries with a prevalence at 1.5% in Italy and 3% in the UK. The American Stroke Association (ASA), a division of the American Heart Association (AHA), published recommendations to promote coordinated systems that improve patient care in 2005. The Helsingborg Declaration 2006 on European Stroke Strategies reported on evidence-based care and evaluated different models of stroke services. Furthermore, in 2010 the Australian National Stroke Foundation published clinical guidelines that all stroke patients admitted to hospital be managed using a clinical pathway.
These are structured, multidisciplinary plans of care designed to
improve the continuity and co-ordination of care. However, there is
little prospective data on their effectiveness.

A multicenter cluster randomized control trial published recently in BMC Medicine determined the impact of a program of structured care for patients with ischemic stroke. The Clinical Pathways for Effective and Appropriate Care (CPEAC) study
compared 236 patients receiving clinical pathway directed care with 238
patients receiving usual care from 14 hospital units in several regions
in Italy. The results showed that patients receiving clinical pathway
based care had lower 7 day mortality and had a higher likelihood of
returning to daily life, compared with those receiving usual care.
Additionally, the 30-day mortality was lower in the patient group
receiving the intervention compared with the control group but the
difference did not reach significance.  Organized care and the variety
of care was more frequently utilized by patients in the experimental
group compared with those in the control group. Furthermore, compared
with usual care the proportion of patients receiving organized care was
significantly higher in the group on the intervention.

The
findings from the study are in favor of clinical pathways that help
provide a better, comprehensive and specialized care to patients
affected by stroke. Patients’ satisfaction, quality of life,
cost-effectiveness and the use of reperfusion therapy were not evaluated
in the study. Thus further studies are required as suggested by the
authors. Overall, clinical pathways were found to be more effective than
usual care for treating stroke patients in hospital, providing
prospective evidence for their usefulness.

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