A care model for stroke patients from the hospital to the community Yang Si Surat district, MahaSarakham province

Abstract

Introduction: Stroke is a major health concern. Continuous care of stroke patients from the hospital to their homes helps improve the quality of rehabilitation.

Research Objectives:  The study aimed to: 1) assess the situation;  2) develop a new model for caring stroke patients from hospital to community; and 3)  evaluate the results after using the model.  

Research methodology: This R & D study consisted of 3 phases as follow 1) Situation investigation, 2) Model development, and 3) Study the results of using the model. The sample was stroke patients and their caregivers, and a multidisciplinary team/community network comprising 30 people using purposive sampling. The tools were an assessment form on the patient's ability to perform daily activities (Barthel Index) and a satisfaction survey Processing time June- August 2022. Quantitative data were analyzed using descriptive statistics and paired t- test. Qualitative data were analyzed using content analysis.

Results: The findings revealed that 1) Patients and caregivers lacked confidence in self-rehabilitation, data transfer between hospitals and communities was delayed, and 2) The model developed comprised a guideline for caring for stroke patients from the hospital to the community, a self-care manual for stroke patients, and new clear guidelines for follow-up home visits with a system to transmit home visit information to the health service network. 3) The patients’ ability to perform daily activities significantly increased (p<.05).

Conclusions: Rehabilitation of stroke patients by caregivers, multidisciplinary teams, and community networks helps stroke patients perform more daily activities.

Implications: A specific rehabilitation model should be developed for stroke patients with limited daily practice to enhance the effectiveness of recovery.