Psychological services for people with stroke: compliance with the U.K. National Clinical Guidelines.
BACKGROUND
The UK National Clinical Guidelines for Stroke (2000) include recommendations on psychological services. The third National Sentinel Audit of Stroke was completed in 2001-2002.


OBJECTIVE
To examine the extent to which UK stroke services complied with the national guidelines.


METHODS
Use of three retrospective case note audits of hospital admissions, covering the period from admission to six months after discharge, and audits of how stroke services were organized.


METHODS
Hospitals within England, Wales, Northern Ireland, the Channel Islands and the Isle of Man.


METHODS
Stroke patients admitted consecutively within a three-month time frame.


METHODS
Compliance with the guidelines on mood disorders and cognitive impairments, and changes between audits.


RESULTS
The 2001-2002 audit provided data on 60% of possible participants, from 145 hospitals and 5152 patients. Compliance with the guideline to screen for mood disturbance was poor; the median patient compliance rate of hospitals was 50%. More hospitals (88%) had a locally agreed cognitive assessment protocol in 2001-2002 than in 1998 (68%) and in 1999 (82%). However, actual rates of screening for cognitive difficulties were lower than implied by the existence of a local protocol. There were no strong case-mix associates of mood and cognitive screening. Access to clinical psychologists was poor. Mood and cognitive assessment rates were not much better for stroke units with access to clinical psychologists than for units without access (mood: p = 0.6, cognition: p = 0.09).


CONCLUSIONS
Although compliance with some of the guidelines has improved, many areas in current psychological services for stroke urgently need attention.
Bowen
Audrey
A
Humanities, University of Manchester, Oxford Road, Manchester M13 9PL, UK. audrey.bowen@manchester.ac.uk
Knapp
Peter
P
Hoffman
Alex
A
Lowe
Derek
D
D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis* / Q000209:etiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D006113:United Kingdom