A Call for a Stroke Referral Network Between Primary Care and Stroke-Ready Hospitals in the Philippines

Abstract

Background: The increasing stroke burden, inequity in the distribution of local neurologists, and the recent signing of the Universal Health Care Law in the Philippines provide compelling reasons for policy-makers to devise strategies to establish networks between primary care and stroke-ready hospitals. In this review, we explored the current literature and evidence that emphasized the roles of primary care providers (PCPs) and specialists, care transition, and telemedicine/teleneurology in various stages of stroke management. Review Summary: Clear delegation of stroke care responsibilities among PCPs and specialists is needed. Due to the limited number of specialists/neurologists, PCPs may contribute to addressing the insufficiency of community knowledge of acute stroke symptoms/risk factors, coordination with specialists and stroke-ready hospitals during acute stroke, and continuity of care during the poststroke stage. At present, the Philippines has only 49 stroke-ready hospitals; thus, an efficient and functional referral system for the care transition between the PCPs and specialists must be organized in our country. To provide remote access to expert stroke care for underserved areas and to increase thrombolysis utilization, the establishment of an effective telestroke system is indispensable. The empowerment of PCPs in teleneurology may assist in strengthening communication and networking with specialists with the ultimate goal of improving patient outcomes. Conclusions: In the era of Universal Health Care in the Philippines, the roles of PCP and specialists must be delineated. Increased access to stroke care through the establishment of networks among PCPs and stroke-ready hospitals (ie, via effective transition of care/teleneurology) must be prioritized especially in resource-constrained settings.

Strengthening stroke prevention and awareness in the Philippines: a conceptual framework

“…their medical concerns, especially those suffering from chronic lifestyle diseases to avoid being infected by the virus and thus, were lost to follow-up with their physicians. Furthermore, despite noted challenges in stroke care referral systems in the country and lack of delineation between primary care and specialist in low-resource settings (5), the pandemic has caused disruptions in healthcare access and utilization, particularly among lowerincome individuals who may face financial barriers to seeking medical care. Since then, tertiary healthcare facilities have also tried to adapt to the challenges imposed by the pandemic.…”