PREHOSPITAL MEDICAL CARE FOR ACUTE CEREBROVASCULAR ACCIDENT. THE FIRST RESULTS OF THE REFORM ON THE EXAMPLE OF ODESA REGION
DOI:
https://doi.org/10.11603/1681-2786.2020.1.11211Keywords:
acute cerebrovascular accident, prehospital phase, medical care, public healthAbstract
Purpose: to evaluate the effectiveness of the provision of prehospital care for stroke in the context of reforming the national health system using the example of the Odesa region.
Materials and Methods. A retrospective analysis of the activities of emergency medical care was carried out in 2016–2018 (before the implementation of the reform) and in 2018–2019.
Results. The analysis showed that on average, (1160±29) patients were hospitalized in the region every year through the EMC system, which is 47.7 cases per 100.000 population. The mean age of patients hospitalized for EMC was (62.6±3.8) years, with a gender ratio of 1/1.2 with a slight male predominance. The largest number of stroke cases was recorded in summer (61.4 %). About 25–30 % of emergency medical care calls are not completed by the hospitalization of a stroke patient. The reasons for refusal are related to the wish of the patient or his relatives to be treated on an outpatient basis (13.5 %), the presence of physicians or medical professionals among the relatives (11.7 %), lack of funds (18.9 %), family circumstances (6.3 %), the general serious condition of the patient (4.5 %). After the introduction of the new concept of emergency care, the number of hospital refusals in the presence of stroke decreased by 2.5 times, the number of patients admitted to the hospital within the therapeutic window increased by 36.3 %. The experience of creating regional clinical and transport protocols for maximum time reduction and optimal treatment at all stages of care is discussed.
Сonclusion. The implementation of the reform improved the quality of pre-hospital care for stroke, the number of refusals from hospitalization in the presence of stroke decreased by 2.5 times, the number of patients admitted to the hospital within the therapeutic window increased by 36.3 %. The problem of unreasonable refusals of patients with stroke and their relatives from urgent hospitalization remains crucial. The introduction of standardized operating procedures for the provision of prehospital care aimed at reducing the time for patients transportation to the hospital is discussed.
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