title: Analysis of stroke care resources in Spain in 2012: have we benefitted from the Spanish Health System's stroke care strategy?
abstract: BACKGROUND
  The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets.
  
  
  METHODS
  The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability.
  
  
  RESULTS
  We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine.
  
  
  CONCLUSIONS
  Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.
authors.affiliation: Servicio de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España. Electronic address: jclopezfdez@gmail.com.
authors.forename: J C
authors.initials: JC
authors.lastname: López Fernández
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
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authors.lastname: Masjuan Vallejo
authors.affiliation: Servicio de Neurología, Hospital Clínico de Valladolid, Valladolid, España.
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authors.initials: J
authors.lastname: Arenillas Lara
authors.affiliation: Servicio de Neurología, Hospital Clínico de Santiago, Coruña, España.
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authors.lastname: Blanco González
authors.affiliation: Sección de Neurología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
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authors.lastname: Botia Paniagua
authors.affiliation: Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
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authors.lastname: Casado Naranjo
authors.affiliation: Servicio de Neurología, Hospital de Manacor, Manacor, Mallorca, España.
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authors.lastname: Deyá Arbona
authors.affiliation: Servicio de Neurología, Hospital Virgen de la Arrixaca, Murcia, España.
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authors.lastname: Escribano Soriano
authors.affiliation: Servicio de Neurología, Hospital de Basurto, Bilbao, Vizcaya, España.
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authors.lastname: Freijo Guerrero
authors.affiliation: Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Instituto de Investigación IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
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authors.affiliation: Servicio de Neurología, Hospital de Navarra, Pamplona, Navarra, España.
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authors.lastname: Gállego Cullere
authors.affiliation: Servicio de Neurología, Hospital General de Castellón, Castellón, España.
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authors.lastname: Geffners Sclarskyi
authors.affiliation: Servicio de Neurología, Hospital Gregorio Marañón, Madrid, España.
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authors.lastname: Gil Núñez
authors.affiliation: Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
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authors.lastname: Gómez Escalonilla
authors.affiliation: Servicio de Neurología, Hospital Universitari La Fe, Valencia, España.
authors.forename: A
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authors.lastname: Lago Martin
authors.affiliation: Servicio de Neurología, Hospital Son Espases, Palma de Mallorca, Mallorca, España.
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authors.lastname: Legarda Ramírez
authors.affiliation: Servicio de Neurología, Hospital Mexoeiro, Vigo, Pontevedra, España.
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authors.initials: JL
authors.lastname: Maciñeiras Montero
authors.affiliation: Servicio de Neurología, Hospital Virgen de las Nieves, Granada, España.
authors.forename: J
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authors.lastname: Maestre Moreno
authors.affiliation: Servicio de Neurología, Hospital Virgen del Rocío, Sevilla, España.
authors.forename: F
authors.initials: F
authors.lastname: Moniche Álvarez
authors.affiliation: Servicio de Neurología, Hospital de Navarra, Pamplona, Navarra, España.
authors.forename: R
authors.initials: R
authors.lastname: Muñoz Arrondo
authors.affiliation: Servicio de Neurología, Hospital Arnau de Vilanova, Lleida, España.
authors.forename: F
authors.initials: F
authors.lastname: Purroy García
authors.affiliation: Servicio de Neurología, Hospital Infanta Cristina, Badajoz, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Ramírez Moreno
authors.affiliation: Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España.
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authors.lastname: Rebollo Álvarez Amandix
authors.affiliation: Servicio de Neurología, Hospital del Mar, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Roquer
authors.affiliation: Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Rubio Borrego
authors.affiliation: Servicio de Neurología, Hospital General de Albacete, Albacete, España.
authors.forename: T
authors.initials: T
authors.lastname: Segura
authors.affiliation: Servicio de Neurología, Hospital San Pedro, Logroño, España.
authors.forename: M
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authors.lastname: Serrano Ponza
authors.affiliation: Servicio de Neurología, Complejo Hospitalario de León, León, España.
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authors.initials: J
authors.lastname: Tejada García
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario, Zaragoza, España.
authors.forename: C
authors.initials: C
authors.lastname: Tejero Juste
authors.affiliation: Sección de Neurología, Hospital Valle del Nalón, Langreo, Asturias, España.
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mesh_terms: D057510:Endovascular Procedures / Q000379:methods; D006295:Health Resources / Q000600:supply & distribution*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006761:Hospitals; D006801:Humans; D009462:Neurology; D011787:Quality of Health Care; D013030:Spain; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000379:methods; D000078329:Workforce
keywords: Encuesta recursos; Stroke facilities survey; Stroke treatment; Stroke unit; Thrombolysis; Tratamiento ictus; Trombolisis; Unidad de ictus