title: What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic.
abstract: BACKGROUND
  Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community.
  
  
  OBJECTIVE
  We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level.
  
  
  METHODS
  A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility.
  
  
  METHODS
  Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI).
  
  
  METHODS
  Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05.
  
  
  RESULTS
  Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2-100) to 90.5 (range: 27-100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0-22) to 3.0 (range: 0-19) though the change was not significant (Z= -0.744, P = 0.457).
  
  
  CONCLUSIONS
  Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.
authors.affiliation: United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia ; Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Aznida Firzah Abdul
authors.initials: AF
authors.lastname: Aziz
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Noor Azah Abd
authors.initials: NA
authors.lastname: Aziz
authors.affiliation: United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia ; Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Nor Azlin Mohd
authors.initials: NA
authors.lastname: Nordin
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Mohd Fairuz
authors.initials: MF
authors.lastname: Ali
authors.affiliation: Department of Health Information, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Saperi
authors.initials: S
authors.lastname: Sulong
authors.affiliation: United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia.
authors.forename: Syed Mohamed
authors.initials: SM
authors.lastname: Aljunid
keywords: Long-term stroke care; poststroke; primary care