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Regional differences in access to acute ischaemic stroke care and patient outcomes
Author(s) -
Dwyer Mitchell,
Peterson Greg,
Gall Seana,
Kinsman Leigh,
Francis Karen,
Ford Karen,
Castley Helen,
Kitsos Alex,
Hilliard Tamsin,
English Jennifer
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14638
Subject(s) - medicine , thrombolysis , stroke (engine) , odds ratio , confidence interval , acute care , psychological intervention , emergency medicine , logistic regression , disadvantaged , confounding , odds , acute stroke , health care , tissue plasminogen activator , nursing , mechanical engineering , myocardial infarction , political science , law , engineering , economics , economic growth
Background Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas being relatively disadvantaged. It remains unclear, however, whether such disparities have led to corresponding differences in patient outcomes. Aims To describe the regional differences in acute ischaemic stroke care and outcomes within the Australian state of Tasmania. Methods A retrospective case note audit was used to assess the care and outcomes of 395 acute ischaemic stroke patients admitted to Tasmania's four major public hospitals. Sixteen care processes were recorded, which covered time‐critical treatment, allied health interventions and secondary prevention. Outcome measures were assessed using 30‐day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression. Results No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients' access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30‐day mortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46–2.18) or discharge destination (OR = 1.24, 95% CI 0.81–1.91). Conclusions With the exception of acute stroke unit care and thrombolysis, acute ischaemic stroke care within Tasmania's urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes. Future studies are encouraged to employ larger data sets, which capture a broader range of urban and rural sites and record patient outcomes at extended interval.