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Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review

Dwyer, MA ORCID: 0000-0002-9956-2569, Rehman, S ORCID: 0000-0003-0056-719X, Ottavi, T, Stankovich, J, Gall, S ORCID: 0000-0002-5138-2526, Peterson, GM ORCID: 0000-0002-6764-3882, Ford, K and Kinsman, L ORCID: 0000-0002-0790-5887 2019 , 'Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review' , Journal of The Neurological Sciences, vol. 397 , pp. 63-74 , doi: 10.1016/j.jns.2018.12.021.

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Objective: To describe literature pertaining to urban-rural differences in both the quality of care and outcomes ofacute stroke patients.Methods: We systematically searched CINAHL, PubMed, ProQuest Dissertations & Theses, and Scopus for published and unpublished literature until 9th December 2017. Studies were included if they compared the acutecare provided to, or outcomes of, patients hospitalised for stroke in urban versus rural settings. Abstract, full-textreview, and data extraction were conducted in duplicate. Findings are presented in the form of narrativesyntheses.Results: A total of 28 studies were included in the review (16 on care, 12 on outcomes). With few exceptions,studies addressing the provision of care suggested that rural patients have less access to most aspects of acutestroke care. Studies reporting urban-rural differences in patient outcomes were inconsistent in their findings,however, few of these studies were primarily focused on the issue of urban-rural disparities. Overall, studyfindings did not appear to differ in line with study quality ratings, stroke subtypes included, or how inter-facilitypatient transfers were accounted for.Conclusions: There is convincing, albeit not unanimous, evidence to suggest that stroke patients in rural areasreceive less acute care than their urban counterparts. Despite this, the available data and methodology havelargely not been used to study urban-rural differences in patient outcomes.

Item Type: Article
Authors/Creators:Dwyer, MA and Rehman, S and Ottavi, T and Stankovich, J and Gall, S and Peterson, GM and Ford, K and Kinsman, L
Keywords: stroke, urban, rural, care, management, hospital, acute
Journal or Publication Title: Journal of The Neurological Sciences
Publisher: Elsevier Science Bv
ISSN: 0022-510X
DOI / ID Number: 10.1016/j.jns.2018.12.021
Copyright Information:

Copyright 2018 Elsevier B.V.

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