 Inequalities persist, despite improving UK stroke care

Although the quality of stroke care in the UK is improving, significant inequalities still exist, according to a new study(1) published recently on bmj.com.

While the receipt of effective stroke care has improved over the last decade, inequalities in its provision were significant, and implementation of evidence based care has not been optimal, its authors claim.

Researchers assessed the provision of acute stroke care for 3,800 patients, with first ever ischaemic stroke or primary intracerebral haemorrhage, registered on the south London stroke register between January 1995 and December 2009.   They measured the provision of effective acute stroke care, in line with current guidelines, against demographic factors such as age, sex, ethnic origin and socioeconomic status.

The proportion of patients receiving effective care interventions increased substantially during the period.   However, between 2007 and 2009, 5% of patients were still not admitted to hospital after an acute stroke, particularly those with milder strokes, and 21% of patients were not admitted to a stroke unit.

Effective care was accessed disproportionately, researchers found. For example, compared with white patients, black patients had significantly increased odds of being admitted to a stroke unit and receiving occupational therapy or physiotherapy, independent of age or stroke severity.   The odds of brain imaging were lowest in older patients (aged ≥75) and those of lower socioeconomic status, whereas older patients were more likely to receive occupational therapy or physiotherapy.

Despite a government goal of universal access to healthcare, the findings of this study suggest a disproportionate access to acute stroke care, say the authors. They conclude that strategies to minimise these inequalities are urgently needed to increase the chances that all patients receive optimal care with improved outcomes.

References

Addo J, Bhalla A, Crichton S, Rudd AG, McKevitt C, Wolfe CDA. Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register. BMJ 2011;342: doi:10.1136/bmj.d744