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Regional differences in access to acute ischaemic stroke care and patient outcomes

Dwyer, MA ORCID: 0000-0002-9956-2569, Peterson, G ORCID: 0000-0002-6764-3882, Gall, S ORCID: 0000-0002-5138-2526, Kinsman, L, Francis, K ORCID: 0000-0003-3578-2498, Ford, K, Castley, H, Kitsos, A ORCID: 0000-0003-4319-1559, Hilliard, T and English, J 2020 , 'Regional differences in access to acute ischaemic stroke care and patient outcomes' , Internal Medicine Journal, vol. 50 , 965–971 , doi:

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Background: Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas beingrelatively disadvantaged. It remains unclear, however, whether such disparities haveled to corresponding differences in patient outcomes.Aims: To describe the regional differences in acute ischaemic stroke care and outcomeswithin the Australian state of Tasmania.Methods: A retrospective case note audit was used to assess the care and outcomes of395 acute ischaemic stroke patients admitted to Tasmania’s four major public hospitals.Sixteen care processes were recorded, which covered time-critical treatment, alliedhealth interventions and secondary prevention. Outcome measures were assessed using30-day mortality and discharge destination, both of which were analysed for differencesbetween urban and rural hospitals using logistic regression.Results: No patients in rural hospitals were administered thrombolysis; these hospitalsalso did not have acute stroke units. With few exceptions, patients’ access to theremaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-daymortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46–2.18) or dischargedestination (OR = 1.24, 95% CI 0.81–1.91).Conclusions: With the exception of acute stroke unit care and thrombolysis, acuteischaemic stroke care within Tasmania’s urban and rural hospitals was broadly similar.No significant differences were found between regions in terms of patient outcomes.Future studies are encouraged to employ larger data sets, which capture a broaderrange of urban and rural sites and record patient outcomes at extended interval.

Item Type: Article
Authors/Creators:Dwyer, MA and Peterson, G and Gall, S and Kinsman, L and Francis, K and Ford, K and Castley, H and Kitsos, A and Hilliard, T and English, J
Keywords: stroke, regional, delivery of healthcare, urban health, rural health, outcome assessment (healthcare)
Journal or Publication Title: Internal Medicine Journal
Publisher: Blackwell Publishing Asia
ISSN: 1444-0903
DOI / ID Number:
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Copyright 2019 Royal Australasian College of Physicians

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