Optimising healthcare for stroke survivors - a study of health professional perspectives on minimising treatment burden and maximising patient capacity

Problem

Treatment burden is the healthcare workload experienced by individuals with long-term conditions and the impact this has on well-being. Excessive treatment burden can negatively affect quality of life, adherence to treatment and resource utilisation. Patient capacity is the ability an individual has to manage their life and health problems and is dependent on a variety of physical, psychological and social factors. Previous work has suggested that individuals with stroke experience considerable treatment burden and limitations on their capacity to manage their health. To inform the development of interventions aimed at minimising treatment burden and maximising patient capacity it is important to develop an understanding of the potential barriers and enablers involved.We aimed to examine the potential barriers and enablers to minimising treatment burden and maximising patient capacity faced by stroke care managers and providers.

Approach

A stakeholder panel consisting of stroke survivors and health professionals was involved throughout the design, undertaking and reporting of this study. After gaining informed, written consent, face-to-face qualitative interviews were conducted with individuals involved in either delivering or planning healthcare for stroke survivors in NHS Greater Glasgow and Clyde over the previous five years. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis until data saturation was reached. NVivo software was used to aid data analysis.

Findings

Participants included stroke consultants, nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, general practitioners, health service managers and policy makers. The following broad areas were identified as barriers to minimising treatment burden and maximising patient capacity: inadequate information provision; insufficient staffing numbers and training; poor care co-ordination between primary and secondary care, and between health and social care; confusing discharge processes; difficulty accessing services in the community; difficulty accessing financial aid, particularly those aged <65 years; and lack of psychological support. Identified enablers included: positive personal attributes and skills; good physical and cognitive abilities; proactive support network; higher financial status; and good local environment.

Consequences

Healthcare providers and planners described a number of important barriers and enablers to providing care that minimises treatment burden and maximises patient capacity following stroke. The barriers identified were viewed as being responsible for generating a significant amount of healthcare workload for stroke survivors and to impact on patient capacity. Our findings have important implications for the design and implementation of stroke care pathways, highlighting areas which should be prioritised such as the need for good information provision and improved care co-ordination.