Limited stroke unit access underlies poor rural patient outcomes
MedWire News: Disparities in stroke outcomes between rural and urban patients with stroke are partly driven by access to stroke units, say Australian researchers.
“Continuing efforts need to be made to improve stroke treatment in rural areas to narrow the ‘inequity of outcomes’ gap between rural communities and their metropolitan counterparts,” say Christopher Levi (Hunter Medical Research Institute, Newcastle, Australia) and co-workers.
The team studied 2254 patients admitted to 32 urban and 12 rural hospitals. Fifty-five per cent of the patients were treated in urban hospitals, and 77% of these received treatment in a stroke unit, compared with just 3% of patients admitted to rural hospitals.
Overall, 13% of patients treated in rural hospitals died in hospital, compared with 8% of those treated in urban hospitals, equating to a 46% risk increase associated with treatment in rural hospitals. This association was independent of variables including age, gender, and prognostic variables such as arm deficit, speech impairment, and ability to walk at admission.
Patients treated in rural hospitals were also 75% more likely to be functionally dependent at discharge and 66% more likely to suffer a severe complication than those treated in urban hospitals.
The increased risk for death and severe complications associated with treatment in a rural hospital disappeared after accounting for access to a stroke unit. But the increased risk for dependency remained.
The researchers speculate that this may be because there was only one rural stroke unit in the study, which contributed just 32 patients and was recently established at the time of the study.
They conclude in the Internal Medicine Journal: “Initiatives to increase the equitable access to evidence-based stroke services in Australia are important if we are to reduce the burden of this disease.”
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By Eleanor McDermid