Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Mellor, Ruth M; Bailey, Sr; Sheppard, James P; Carr, Peter; Quinn, Tom; Boyal, Amunpreet; Sandler, David; Sims, Don; Mant, Jonathan; Greenfield, Sheila; McManus, Richard J

doi:10.1016/j.annemergmed.2014.10.018

Cited by 42 publications

(38 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If patients have no knowledge or incorrect knowledge of CVD signs and symptoms, they might be less likely to seek CVD screening or related healthcare services at an earlier stage of the disease process when these signs and symptoms first appear. (18,19) Unfortunately, these patients may only seek CVD screening services when it is too late and the CVD has reached an advanced stage where there is high morbidity and mortality. Therefore, the importance of appropriate CVD knowledge in at-risk populations also extends to signs and symptoms.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey

Dellar

Madiba²,

Moodley

2019

SAHJ

View full text Add to dashboard Cite

HIV-positive surgical population. Surgical patients are often hospitalised for several days around the time of their procedures, and this provides an opportunity to deliver health promotion activities in this patient group. Furthermore, the lessons learned through health promotion activities can instil positive behavioural changes which extend beyond the post-operative period, long after the patient has been discharged from hospital. However, effective planning of any such intervention requires establishing the baseline knowledge and understanding of CVD in this group. Therefore, the objective of this study was to explore the baseline knowledge of CVD risk factors and symptoms in a sample of HIV-positive surgical patients from Durban, South Africa. CVD IN SA SURGICAL PATIENTS ABSTRACT Background: Medical and surgical HIV-positive patients are at risk of cardiovascular disease (CVD). Surgical patients are admitted to hospital for a few days around the time of their surgeries, allowing suffi cient opportunity for health promotion interventions. Health promotion could improve CVD knowledge and encourage lifelong healthy behaviours. However, this approach requires that baseline CVD knowledge fi rst be established. This study sought to determine the knowledge of CVD in HIV-positive South African (SA) surgical patients. Methods: This was a prospective pilot survey of HIVpositive surgical patients who attended a tertiary hospital in Durban, South Africa, between 1 October 2016 and 31 March 2017. Patients completed 2 questionnaires: (1) a demographic characteristics questionnaire, and (2) a CVD knowledge questionnaire (identifying risk factors and signs/symptoms of myocardial infarction and stroke). All data were analysed using descriptive statistical methods. Results: The study sample consisted of 39 HIV-positive surgical patients. Correct responses for the items on the CVD knowledge questionnaire ranged between 0.0% and 61.5% for risk factors, and between 0.0% and 89.7% for signs/symptoms. Conclusion: Knowledge of CVD risk factors and signs/ symptoms in this study was less than desirable. Levels of CVD knowledge are likely a function of educational attainment. SAHeart 2019;16:128-131 Non-white ethnicity 0 (0.0) 0 (0.0) Medications (ART) 0 (0.0) 4 (10.3) Obesity 4 (10.3) 0 (0.0) Unhealthy diet 8 (20.5) 4 (10.3) Excessive alcohol use 3 (7.7) 0 (0.0) Lack of exercise 3 (7.7) 0 (0.0) Stress 24 (61.5) 24 (61.5) CVD = cardiovascular disease, ART = antiretroviral therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey

Dellar

Madiba²,

Moodley

2019

SAHJ

View full text Add to dashboard Cite

show abstract

“…Delayed responses were defined as those where simulated patients were not treated as an emergency and included being advised to attend an out-of-hours service or being offered an appointment with the GP the following day. Being advised to make their own way to the emergency department was also defined as a delayed response because patients can further delay attendance if they do not recognise the urgency of the situation, 17 and will not receive pre-hospital assessments and pre-notification by the EMS which are known to increase the likelihood of receiving emergency care (that is, thrombolysis) in acute stroke. 18 – 20 …”

Section: Methodsmentioning

confidence: 99%

Receptionist rECognition and rEferral of Patients with Stroke (RECEPTS): unannounced simulated patient telephone call study in primary care

et al. 2015

View full text Add to dashboard Cite

BackgroundStroke is a leading cause of morbidity and mortality. Timely recognition and referral are essential for treatment.AimTo examine the ability of receptionists in general practices to recognise symptoms of stroke and direct patients to emergency care.Design and settingUnannounced simulated patient telephone calls and prospective cross-sectional survey study in general practices in the Birmingham and Solihull area.MethodA total of 52 general practices participated in a total of 520 simulated telephone calls, with 183 receptionists completing questionnaires. Logistic regression analyses were used to examine likelihood of referral for immediate care by ease of vignette recognition and number of common stroke symptoms present.ResultsGeneral practice receptionists correctly referred 69% of simulated calls for immediate care. Calls classed as ‘difficult’ to recognise were less likely to be immediately referred. Compared with ‘easy’ calls: ‘difficult’ calls odds ratio (OR) 0.15, 95% confidence interval (CI) = 0.08 to 0.26; ‘moderate’ calls OR 0.55, 95% CI = 0.32 to 0.92. Similarly, calls including one or two ‘FAST’ symptoms were less likely to be referred immediately (compared with three FAST symptoms: one symptom OR 0.30, 95% CI = 0.13 to 0.72; two symptoms OR 0.35, 95% CI = 0.15 to 0.83).ConclusionGeneral practice receptionists refer patients with stroke for immediate care when they present with several symptoms; however, they are less likely to refer patients presenting with only one symptom or less common symptoms of stroke. Optimum management of acute stroke in primary care requires interventions that improve receptionists’ knowledge of lesser-known stroke symptoms.

show abstract

“…(12)(13)(14)(15) Qualitative studies of TIA/minor stroke have predominantly focussed on patients' experiences of initial symptoms, symptom recognition and help seeking behaviour. (16)(17)(18)(19) However, some studies have explored patients' experiences after the acute stage and reported a diverse range of residual impairments, including: anxiety, (20)(21)(22)(23)(24)(25)(26) mood/emotional impact, (20,21,23,26) cognitive impairment, (21,26) fatigue, (23,25,27) physical weakness, (21,23,25) visual impairments (25) and impaired speech. (21) The impact of TIA/minor stroke on patients' ability to return to work, (25)(26)(27) performance at work, (20,25) social activities (20,21,23,26,27) and family relationships has also been reported.…”

Section: Introductionmentioning

confidence: 99%

TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care

Turner

McMullan

Atkins

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems. Conclusion HCPs could better communicate lay information about TIA/minor stroke diagnosis and secondary stroke prevention, and improve their identification of and response to important residual impairments affecting patients.

show abstract

Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Cited by 42 publications

References 31 publications

Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey

Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey

Receptionist rECognition and rEferral of Patients with Stroke (RECEPTS): unannounced simulated patient telephone call study in primary care

TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care

Contact Info

Product

Resources

About