title: [Outpatient management of stroke patients from the viewpoint of general practitioners in Hamburg--an exploratory study].
abstract: OBJECTIVE
  Stroke is the archetype of a chronic disease, with a considerable burden on ambulatory care. After discharge from hospital or inpatient rehabilitation, stroke patients are attended primarily by general practitioners (GPs). Little is known about the quality of outpatient care for stroke patients, so this study focused on the views of professionals involved in outpatient care.
  
  
  METHODS
  A postal survey of 443 general practitioners from Hamburg, Germany was undertaken. Results were compared with a parallel survey carried out with physiotherapists and occupational therapists.
  
  
  RESULTS
  89 questionnaires were analysed. Based on a response rate of 28% the results cannot be seen as representative, but they do provide important information. As it seems, problems in ambulatory care do not start after discharge from hospital, but are partly caused by inpatient care. GPs see therapeutic benefits in ambulatory care for only half of their chronic stroke patients. They assess their own therapeutic efforts as effective in terms of medication, but they are less successful in changing their patients' behaviour with regard to lifestyle. Estimations of the prevalence of post-stroke depression vary substantially, with a mean of 47%. With regard to their daily practice, 60% of GPs do not find guidelines to be helpful. All in all, respondents describe the situation of chronic stroke patients and their families to be complex and difficult to manage. In addition to their professional performance, GPs carry out duties related to case management - as do the therapists.
  
  
  CONCLUSIONS
  The care of stroke patients is not only the responsibility of a single group of professionals, but is a rather complex task involving different health-care professionals. The rehabilitation process and the interdisciplinary cooperation need to be further analysed to ensure a good cooperation between health-care professionals and to improve the quality of ambulatory care for stroke patients.
authors.affiliation: Wissenschaftliche Mitarbeiterin, Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf. a.barzel@uke.uni-hamburg.de
authors.forename: A
authors.initials: A
authors.lastname: Barzel
authors.forename: M
authors.initials: M
authors.lastname: Eisele
authors.forename: H van den
authors.initials: Hv
authors.lastname: Bussche
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires