Integration in stroke services: the challenges for primary and community care services.

Objectives A number of evidence-based interventions are now available for stroke patients. Good quality stroke care involves a range of health professionals located across ambulance, hospital, community and primary care services. This study examined the perspectives of healthcare workers involved in stroke care in two different English case study sites on the integration challenges stroke care presents. Methods Two qualitative case studies were carried out, including 45 semi-structured interviews with clinicians and managers associated with two different hospitals providing specialised stroke services. Findings High levels of organisational, functional, service and clinical integration amongst clinicians that deliver emergency and acute stroke care were identified. This is frequently lacking amongst professionals delivering post-acute care. These findings are linked to the prevalence or lack of normative and systemic integration in each respective stage of care. Conclusions Emphasis on the need to treat stroke as an emergency condition in England over recent years has created a context in which normative and systemic integration often occurs amongst clinicians that deliver emergency and acute stroke care, aiding the development of organisational, functional, service and clinical integration across the case study sites. In contrast, integration between hospital and community (rehabilitation and general practice) care is frequently less successful.