Dwyer, M and Peterson, G and Gall, S and Francis, K and Kitsos, A and Kinsman, L and Ford, K and Castley, H and Hilliard, T and English, J, Urban-rural differences in access to acute stroke care and patient outcomes, SSA 2019 Conference, 10-13 September 2019, Canberra, pp. 19. ISSN 1747-4949 (2019) [Conference Extract]
Official URL: https://www.anzsnr.org.au/newevents/2019/9/10/stro...
Background: Australia’s stroke burden has reduced over time, partially due to advances made in the field of acute stroke care. These advances are not uniformly distributed throughout our population, with rural areas often being relatively disadvantaged. It remains unclear, however, whether such disparities are associated with corresponding differences in patient outcomes.
Aims: To describe the urban-rural differences in acute stroke care and outcomes within the Australian state of Tasmania.
Methods: A retrospective case note audit was used to assess the care and outcomes of 395 acute stroke patients admitted to Tasmania’s four major public hospitals. Sixteen care processes were recorded; these covered time-critical treatment, allied health interventions, and secondary prevention. Outcome measures were assessed using 30-day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression models.
Results: No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients’ access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-day mortality (OR = 0.99, 95% C.I. 0.46–2.18) or discharge destination (OR = 1.24, 95% C.I. 0.81–1.91).
Conclusion: With the exception of acute stroke unit care and thrombolysis, acute stroke care within Tasmania’s urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes, although future studies are encouraged to employ larger datasets, and record patient outcomes at extended intervals.
|Item Type:||Conference Extract|
|Keywords:||Stroke, neurology, unwarranted variation|
|Research Division:||Health Sciences|
|Research Group:||Health services and systems|
|Research Field:||Health systems|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Health inequalities|
|UTAS Author:||Dwyer, M (Dr Mitchell Dwyer)|
|UTAS Author:||Peterson, G (Professor Gregory Peterson)|
|UTAS Author:||Gall, S (Associate Professor Seana Gall)|
|UTAS Author:||Francis, K (Professor Karen Francis)|
|UTAS Author:||Kitsos, A (Mr Alex Kitsos)|
|UTAS Author:||Kinsman, L (Professor Leigh Kinsman)|
|UTAS Author:||Ford, K (Dr Karen Ford)|
|UTAS Author:||Castley, H (Dr Helen Castley)|
|UTAS Author:||Hilliard, T (Miss Tamsin Hilliard)|
|UTAS Author:||English, J (Dr Jennifer English)|
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