Urban-rural differences in access to acute stroke care and patient outcomes

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.