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Gaps in care for patients with memory deficits after stroke: Views of healthcare providers

Lookup NU author(s): Dr Eugene Tang, Dr Christopher Price, Dr Blossom Stephan, Professor Dame Louise Robinson, Professor Catherine Exley

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2017 The Author(s). Background: Stroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care. Methods: Seventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation. Results: Data analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care. Conclusions: The care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.


Publication metadata

Author(s): Tang EYH, Price C, Stephan BCM, Robinson L, Exley C

Publication type: Article

Publication status: Published

Journal: BMC Health Services Research

Year: 2017

Volume: 17

Online publication date: 08/09/2017

Acceptance date: 25/08/2017

Date deposited: 20/10/2017

ISSN (electronic): 1472-6963

Publisher: BioMed Central Ltd

URL: https://doi.org/10.1186/s12913-017-2569-5

DOI: 10.1186/s12913-017-2569-5


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