NHS Greater Glasgow today launched an innovative new community-based stroke service to improve the care and treatment of thousands of patients who experience a stroke each year.
The new service will ensure all stroke patients have access to a comprehensive annual assessment and, if required, are referred to a new Primary Care Stroke Therapy Team. Detailed information will also be collected on the condition of all new stroke patients, prior to their discharge from hospital, to help practice nurses and GPs monitor and compare the patient's actual progress against their expected progress.
The model of service being introduced is the first of its kind in Scotland to offer an automatic annual review and access to dedicated community-based stroke therapy service for all stroke patients - regardless of when their stroke occurred.
John Dennis, Senior Physiotherapist with the new Primary Care Stroke Therapy Team, said: "Services are available in Scotland for patients who have had a recent stroke, especially to support discharge and prevent re-admission to hospital. Our dedicated service, however, is different in that it will offer support and therapy to people who have deteriorated in function even if their stroke occurred some time ago. This is definitely worthwhile as we recently achieved significant improvements in patients whose stroke occurred up to 30 years ago."
The initial annual assessment, which is carried out by practice nurses who have undergone specialist stroke training, is designed, not only to measure physical factors such as blood pressure and coagulation levels, but also mental well being, as depression and anxiety is very common following stroke. In addition, the assessment will look at lifestyle and behavioural factors related to stroke, such as diet, exercise, alcohol consumption and smoking.
If a practice nurse is concerned that any patient is not progressing as well as expected, or has developed new problems or appears to be deteriorating, they will be able to directly refer that patient to a new Primary Care Stroke Therapy Team for more detailed assessment, treatment and support. The team provides physiotherapy (to help with problems of posture and movement), occupational therapy (to help with everyday activities at home, leisure and work), clinical psychology (to help with emotional problems such as anxiety, depression and difficulties with cognitive function such as memory and problem solving) as well as dedicated input from speech and language therapy and the community dietetic service.
Following referral, the Stroke Therapy Team assess the patient in their own home and, if required, develop a programme of therapy designed to meet the patient's individual needs. Once a course of therapy is complete the patient will continue to be reviewed by the practice nurse on an annual basis. It is anticipated that around 10% of stroke patients assessed by practice nurses under the new system will be referred to the primary care stroke team for further support.
This new system of monitoring and assessment will also enable a Stroke Disease Register to be developed which will provide accurate information on the prevalence of stroke across Greater Glasgow and help inform the planning and development of future services.
Ian Reid, Chief Executive of NHS Greater Glasgow Primary Care Division, said: "This new service will vastly improve the quality and consistency of treatment available in the community and ensure that patients and their families have access the same range and level of services and support, regardless of where they live. It will also help identify potential problems early on and ensure that patient's have access to the specialist support required to address these.
David Clark, Chief Executive, Chest, Heart & Stroke Scotland, said: "We welcome this major investment in community-based stroke services and believe it will significantly improve the health and quality of life for present and future stroke patients."
He added: "We are co-operating with this project through our "Communication Partners Initiative", which will help ensure that those patients left with speech and language problems can also benefit from this service."
The development of the new stroke service is part of NHS Greater Glasgow's wider strategy to improve the care and management of patients with chronic diseases such as diabetes, coronary heart disease, stroke, epilepsy, chronic obstructive pulmonary disease, rheumatoid arthritis and multiple sclerosis.
Stroke is the term used to describe the effects of an interruption of the blood supply to a localised area of the brain. Around 12,000 people currently living within Greater Glasgow are currently being treated for stroke related conditions and around 2,000 people experience a stroke each year. More than half of these (60%) are known as Transient Ischaemic Attacks (TIA) or 'mini strokes' which are often a precursor to a full-blown stroke. The effects of a stroke vary enormously, and depend on which part of the brain is damaged and the extent of that damage. For some, the effects are relatively minor and short lived; others are left with more severe, long-term impairments. Common problems can include:
* weakness or paralysis (hemiplegia) on one side of the body with possible sensory loss (loss of touch and movement)
* speech and language problems
* alterations in perception. (there may be a difficulty recognising familiar objects or knowing how to use them and a loss of awareness of body alignment and positioning
* difficulties with cognitive processes such as thinking, learning, concentrating, remembering, decision making, reasoning and planning
* mood swings, depression, anger, low self-esteem and loss of confidence
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