A descriptive study on doctors' practices regarding different aspects of stroke rehabilitation in private acute-care hospitals situated in the Western Cape metropole

[摘要] ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributessignificantly to the burden of disease and is the largest cause of disability. Rehabilitationcan significantly improve recovery and outcomes of stroke survivors particularly ifimplemented in the correct manner and through using certain approaches.The aim of this study was to examine the practice of doctors with regards to strokerehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular,attention has been given to the degree to which doctors in the private health care sectorshared information with first time stroke patients.The study design was retrospective and descriptive in nature.Data collection was primarily of a quantitative nature although some qualitative data hasbeen collected to elaborate on quantitative findings. Two self-designed questionnaireswere used to collect data. Data from doctor-participants were collected to examine theuse of care protocols. Data from both groups of participants were collected to determinewhich practices were prefered. In particular it was sought to ascertain what team workapproach was favoured by doctors. To do this the method of communication among teammembers was examined. It was also sought to ascertain how information regardingdiagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planningwas shared. In total thirty-five doctors and forty-eight patients were interviewed.Quantitative data was captured on an excel spreadsheet and analysed with the help of aSTATISTICA software package. A p value of less than 0.05 was deemed statisticallysignificant.Results showed that none of the doctor participants had any formal rehabilitationqualification. It was found that stroke care protocols were used by 46% of doctorparticipants, while 89% acknowledged the advantages of a set protocol. The majority ofdoctors (57%) operated as part of a multidisciplinary team. Communication between teammembers regarding the patient's management plan was done on a very informal basis withonly 11% of doctors using ward rounds and none using team meetings for this purpose.Opinions differed between the two study groups on the frequency of information sessions(p = .00039). Only six % of doctors included the patient and family in the rehabilitationteam. A large discrepancy was seen when it came to opinions on sharing informationregarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference betweenthe opinions of patients and doctors on these issues was statistically significant. Opinionsalso differed between the two groups when the frequency of information sessions wascompared (p = 0.00039). Only 28% of patient participants were included in the decisionmakingprocess regarding further post-acute rehabilitation and in most cases the finaldecision was made by the doctor or the medical insurance company. Qualitative datahighlighted some patients' dissatisfaction regarding the post-acute rehabilitation processand indicated a problem with regard to the recognition of early stroke warning signs bygeneral practitioners and the emergency treatment of these.The conclusion was that there is a great need for further motivation and education ofdoctors with respect to advanced research projects, further specialisation as well as theimplementation of important rehabilitation modalities. It is also important that the patienthimself acts as a fully-fledged team member.Recommendations were that administrators in both, the private and public health caresectors as well as non-government organisations and government welfare organisationsidentify the reasons for doctors' hesitation to implement existing knowledge; that theymake stroke rehabilitation training available and that they ensure that doctors implementthe existing and new knowledge on all aspects of acute and post-acute strokerehabilitation i.e. use of set care protocols, team work approach and sharing informationon diagnosis, prognosis, risk factors, post–acute rehabilitation options and dischargeplanning when managing stroke patients. It was also recommended to promote moreresearch projects which are implemented in the private health care sector.

[发布机构] Stellenbosch University