Controversies in Management: Community care allows patients to reach their full potential

Publisher Website
Google Scholar
Abstract
Longer term perspective It is now recognised that stroke rehabilitation requires a longer term perspective: probably at least three to five years after the initial stroke.2 This may not seem a particularly awe inspiring notion, but it does represent a crucially different way of considering stroke care - one that clashes with the contemporary “short termism” of hospital practice. There are obvious parallels with other chronic disease such as rheumatoid arthritis where long term systematic follow up with multiprofessional interventions tailored to the individual have resulted in improved and more consistent outcome. Blaxter followed the course of patients with a new disability (including stroke) after hospital discharge.3 The practical difficulties, the intense frustrations, and the hardships were plainly laid out. Two decades later, this experience is little changed despite advances in hospital care for stroke.2 Blaxter came to recognise the continuous nature of this struggle and suggested the term “a career in disability” (which we could now redefine as “a career in stroke”) as an appropriate way to capture the lifestyle changes she observed. Do hospital staff usually consider stroke in these terms? I think not. Hospital staff are entrapped by a short term view with a dominating focus on discharge from hospital as the end point of rehabilitation. Even in stroke units a good start is rapidly dissipated because we hand over the rehabilitation process to a near vacuum of community care.4 The pressing challenge is to develop a community care rehabilitation process based on the proved principles of the stroke unit but which is capable of fulfilling the longer term perspective required by stroke patients and their families.