title: Adherence to Canadian best practice recommendations for stroke care: assessment and management of poststroke depression in an Ontario rehabilitation facility.
abstract: OBJECTIVE
  Although Canadian best practice recommendations regarding assessment and management of poststroke depression (PSD) have been established, the degree to which these evidence-based guidelines have been translated into practice is not known. The objectives of the present study are to compare current and recommended best practice and examine possible reasons for identified care gaps.
  
  
  METHODS
  Practice audit by chart review was performed to identify recorded screening, assessment, and treatment for PSD in patients discharged from a specialized inpatient rehabilitation program over a 6-month period. A questionnaire was administered to all clinical staff addressing current screening practices as well as opinions regarding the importance and feasibility of identification and treatment of PSD.
  
  
  RESULTS
  Of 123 patients, 40 (32.5%) had been prescribed antidepressants at discharge. However, evidence of screening was found for 4.9% of patients; another 9.8% were referred for psychological consult. Treatment was associated with previous antidepressant use or history of depression, but not screening or assessment. Of the survey respondents, 56.2% were not aware of best practice recommendations. However, most felt screening and assessment to be important and treatment was regarded as both simple and effective.
  
  
  CONCLUSIONS
  Despite potential benefit associated with identification and treatment of PSD and the availability of evidence-based best practice recommendations, PSD may remain unrecognized and undertreated. Given the juxtaposition of perceived importance with the lack of documented best practice, education regarding standardized screening and the development of consistent clinical protocols including roles and responsibilities in the identification, diagnosis, and treatment of PSD are underway.
authors.affiliation: Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: J Andrew
authors.initials: JA
authors.lastname: McClure
authors.forename: Hannah
authors.initials: H
authors.lastname: Mahon
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006282:Health Personnel / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation