Daniela C Gonçalves-Bradley1, Anne-Marie Boylan2, Constantinos Koshiaris2, Maria Vazquez Montes2, Gary A Ford3, Daniel S Lasserson4. 1. Nuffield Department of Population Health, University of Oxford Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Oxford OX2 6GG. 2. Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Oxford OX2 6GG. 3. Medical Sciences Division, University of Oxford, Level 3, John Radcliffe Hospital, Oxford OX3 9DU and. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Oxford OX2 6GG, Medical Sciences Division, University of Oxford, Level 3, John Radcliffe Hospital, Oxford OX3 9DU and NIHR Oxford Biomedical Research Centre, The Joint Research Office, Block 60, The Churchill Hospital, Old Road, Headington OX3 7LE, UK. daniel.lasserson@phc.ox.ac.uk.
Abstract
BACKGROUND: Clinical practice guidelines recommend that stroke survivors' needs be assessed at regular intervals after stroke. The extent to which GPs comply with national guidance particularly for patients in care homes who have greatest clinical complexity is unknown. OBJECTIVES: This study aimed to establish the current clinical practice in the UK of needs assessment by GPs for stroke survivors after hospital discharge for acute stroke. METHODS: Cross-sectional online survey of current practice of GPs, using the national doctors.net network. RESULTS: The survey was completed by 300 GPs who had on average been working for 14 years. The structured assessment of stroke survivors' needs was not offered by 31% of GPs, with no significant difference for level of provision in community or care home settings. The outputs of reviews were added to patients' notes by 89% of GPs and used to change management by 57%. Only half the GPs reported integrating the information obtained into care plans and only a quarter of GPs had a protocol for follow-up of identified needs. Analysis of free-text comments indicated that patients in some care homes may receive more regular and structured reviews. CONCLUSIONS: This survey suggests that at least one-third of GPs provide no formal review of the needs of stroke patients and that in only a minority are identified needs addressed in a structured way. Standardization is required for what is included in reviews and how needs are being identified and met.
BACKGROUND: Clinical practice guidelines recommend that stroke survivors' needs be assessed at regular intervals after stroke. The extent to which GPs comply with national guidance particularly for patients in care homes who have greatest clinical complexity is unknown. OBJECTIVES: This study aimed to establish the current clinical practice in the UK of needs assessment by GPs for stroke survivors after hospital discharge for acute stroke. METHODS: Cross-sectional online survey of current practice of GPs, using the national doctors.net network. RESULTS: The survey was completed by 300 GPs who had on average been working for 14 years. The structured assessment of stroke survivors' needs was not offered by 31% of GPs, with no significant difference for level of provision in community or care home settings. The outputs of reviews were added to patients' notes by 89% of GPs and used to change management by 57%. Only half the GPs reported integrating the information obtained into care plans and only a quarter of GPs had a protocol for follow-up of identified needs. Analysis of free-text comments indicated that patients in some care homes may receive more regular and structured reviews. CONCLUSIONS: This survey suggests that at least one-third of GPs provide no formal review of the needs of strokepatients and that in only a minority are identified needs addressed in a structured way. Standardization is required for what is included in reviews and how needs are being identified and met.
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