Using a checklist to facilitate management of long-term care needs after stroke: insights from focus groups and a feasibility study

Grace M Turner, Ricky Mullis, Lisa Lim, Lizzie Kreit, Jonathan Mant, Grace M Turner, Ricky Mullis, Lisa Lim, Lizzie Kreit, Jonathan Mant

Abstract

Background: Long-term needs of stroke survivors are often not adequately addressed and many patients are dissatisfied with care post-discharge from hospital. Primary care could play an important role in identifying need in people with stroke.

Aim: We aimed to explore, refine and test the feasibility and acceptability of a post-stroke checklist for stroke reviews in primary care.

Design and setting: Focus groups (using a generic qualitative approach) and a single-centre feasibility study.

Method: Five focus groups were conducted; three with healthcare providers and two with stroke survivors/carers. The focus groups discussed acceptability of a checklist approach and the content of an existing checklist. The checklist was then modified and piloted in one general practice surgery in the East of England.

Results: The qualitative data found the concept of a checklist was considered valuable to standardise stroke reviews and prevent post-stroke problems being missed. Items were identified that were missing from the original checklist: return to work, fatigue, intimate relationships and social activities. Time constraints was the main concern from healthcare professionals and pre-completion of the checklist was suggested to address this. Thirteen stroke survivors were recruited to the feasibility study. The modified checklist was found to be feasible and acceptable to patients and primary care clinicians and resulted in agreed action plans.

Conclusion: The modified post-stroke checklist is a pragmatic and feasible approach to identify problems post-stroke and facilitate referral to appropriate support services. The checklist is a potentially valuable tool to structure stroke reviews using a patient-centred approach.

Keywords: Long-term care; Primary care; Quality of life; Rehabilitation; Stroke.

Conflict of interest statement

Ethics approval and consent to participate

The focus groups were approved by the East of England Cambridge South Research Ethics Committee (REC) (REC Reference: 15/EE/0374). The feasibility study was approved by the West Midlands Edgbaston REC (REC Reference: 17/WM/0104). Written consent was obtained from the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161–176. doi: 10.1159/000441085.
    1. Gulliford MC, Charlton J, Rudd A, et al. Declining 1-year case-fatality of stroke and increasing coverage of vascular risk management: population-based cohort study. J Neurol Neurosurg Psychiatry. 2010;81(4):416–422. doi: 10.1136/jnnp.2009.193136.
    1. Lee S, Shafe ACE, Cowie MR. UK stroke incidence, mortality and cardiovascular risk management 1999–2008: time-trend analysis from the general practice research database. BMJ Open. 2011;1(2):e000269.
    1. Pindus DM, Mullis R, Lim L, et al. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services - a systematic review and meta-ethnography. PLoS One. 2018;13(2):e0192533. doi: 10.1371/journal.pone.0192533.
    1. Stroke Association. A new era for stroke report 2016. Available from: .
    1. McKevitt C, Fudge N, Redfern J, et al. Self-reported long-term needs after stroke. Stroke. 2011;42(5):1398–1403. doi: 10.1161/STROKEAHA.110.598839.
    1. Philp I, Brainin M, Walker MF, et al. Development of a poststroke checklist to standardize follow-up care for stroke survivors. J Stroke Cerebrovasc Dis. 2013;22(7):e173–e180. doi: 10.1016/j.jstrokecerebrovasdis.2012.10.016.
    1. Anthony BW, Christopher C, Bo N, et al. Evaluation of the post stroke checklist: a pilot study in the United Kingdom and Singapore. Int J Stroke. 2014;9(SA100):76–84. doi: 10.1111/ijs.12291.
    1. National Institute for Health and Care Excellence. NICE Pathways: Stroke. Available from: .
    1. IPCAS – Improving Primary Care After Stroke. Available from: .
    1. Bradbury-Jones C, Breckenridge J, Clark MT, et al. The state of qualitative research in health and social science literature: a focused mapping review and synthesis. Int J Soc Res Methodol. 2017;20(6):627–645. doi: 10.1080/13645579.2016.1270583.
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>;2-G.
    1. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health Care research. Glob Qual Nurs Res. 2017;4:1–8.
    1. Iosa M, Lupo A, Morone G, et al. Post soft Care: Italian implementation of a post-stroke checklist software for primary care and identification of unmet needs in community-dwelling patients. Neurol Sci. 2018;39(1):135–139. doi: 10.1007/s10072-017-3140-1.
    1. Kimura M, Murata Y, Shimoda K, et al. Sexual dysfunction following stroke. Compr Psychiatry. 2001;42(3):217–222. doi: 10.1053/comp.2001.23141.
    1. Mellor RM, Greenfield SM, Dowswell G, et al. Health care professionals’ views on discussing sexual wellbeing with patients who have had a stroke: a qualitative study. PLoS One. 2013;8(10):e78802. doi: 10.1371/journal.pone.0078802.
    1. van der Werf SP, van den Broek HL, Anten HW, et al. Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics. Eur Neurol. 2001;45(1):28–33. doi: 10.1159/000052085.
    1. Choi-Kwon S, Han SW, Kwon SU, et al. Poststroke fatigue: characteristics and related factors. Cerebrovasc Dis. 2005;19(2):84–90. doi: 10.1159/000082784.
    1. Andersen G, Christensen D, Kirkevold M, et al. Post-stroke fatigue and return to work: a 2-year follow-up. Acta Neurol Scand. 2012;125(4):248–253. doi: 10.1111/j.1600-0404.2011.01557.x.
    1. Winward C, Sackley C, Metha Z, et al. A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke. 2009;40(3):757–761. doi: 10.1161/STROKEAHA.108.527101.
    1. Glader EL, Stegmayr B, Asplund K. Poststroke fatigue: a 2-year follow-up study of stroke patients in Sweden. Stroke. 2002;33(5):1327–1333. doi: 10.1161/01.STR.0000014248.28711.D6.
    1. Public Health England . Estimating stroke incidence in England: Utilising electronic general practice data for estimating epidemiological trends in national incidence of stroke. London: Public Health England; 2017.
    1. Singam A, Ytterberg C, Tham K, et al. Participation in complex and social everyday activities six years after stroke: predictors for return to pre-stroke level. PLoS One. 2015;10(12):e0144344. doi: 10.1371/journal.pone.0144344.
    1. Paanalahti M, Berzina G, Lundgren-Nilsson A, et al. Examination of the relevance of the ICF cores set for stroke by comparing with the stroke impact scale. Disabil Rehabil. 2018:1–6. 10.1080/09638288.2017.1396368.
    1. NIHR CLAHRC for Greater Manchester and The Stroke Association. Post-stroke review pilot project: the evaluation report 2010. Available from: .
    1. LoTS care LUNS study team Validation of the longer-term unmet needs after stroke (LUNS) monitoring tool: a multicentre study. Clin Rehabil. 2013;27(11):1020–1028. doi: 10.1177/0269215513487082.
    1. Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ. 2008;337:a485. doi: 10.1136/bmj.a485.
    1. . Improving Primary Care After Stroke (IPCAS) 2017. Available from: .
    1. Bakas T, Clark PC, Kelly-Hayes M, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014;45(9):2836–2852. doi: 10.1161/STR.0000000000000033.
    1. Bakas T, McCarthy M, Miller ET. Update on the state of the evidence for stroke family caregiver and dyad interventions. Stroke. 2017;48(5):e122–e1e5. doi: 10.1161/STROKEAHA.117.016052.

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