The Development of a Pre-hospital Stroke Care System with Health Network Services for Older Adults at Risk of Stroke, Amphoe Nam Yuen, Ubon Ratchathani Province

Abstract

The four objectives of this research and development project included: 1) Identifying the problems and needs among older adults at risk of stroke, 2) Development of a pre-hospital stroke care system with health network services for older adults at risk of stroke, 3) Implementation of the system and 4) Studying the outcomes of the system’s implementation. The research comprised four phases related to its objectives. The first phase involved identifying problems and needs, while the second phase focused on the development of the system. The third phase involved implementing the pre-hospital stroke care system for older adults at risk of stroke, and the outcomes of the system were evaluated in the fourth phase. The participants in each phase were as follows: the first phase included 19 health care networks, the second phase involved 261 village health volunteers, and the participants in the third and fourth phases were 708 older adults at risk of stroke who met the inclusion-exclusion criteria. The research tools included: (1) The older adults' care system with risk stroke in the Pre-hospital Stroke Care System, using a triangulation method, (2) The assessment, which included: Stroke knowledge; Knowledge of stroke warning signs; Knowledge related to how and when to ask for help. The instrument’s subscales had KR20 confidence values of 0.89, 0.90, and 0.92, respectively. Data were analyzed using descriptive statistics, t-tests, and Fisher's exact tests.

        The first phase of the study revealed that 76.43% of older adults who had a stroke did not come to the hospital within the targeted standard time of 180 minutes from symptom onset. Phase 2, involving the development of the care system for older adults at risk of stroke in pre-hospital settings, included setting up a LINE application group to connect relevant health networks, village health volunteers, and community leaders. It also included home visits, posting stickers, pinning high-risk groups, and using a public address system. After receiving training, the mean score of stroke knowledge among village health volunteers was significantly higher than before training (p < .01). The mean scores for knowledge about stroke warning signs and when to ask for help among the older adults at risk for stroke were higher after the intervention in phases 3 and 4. Additionally, the proportion of older adults having a stroke who arrived at the hospital within the targeted time had decreased significantly (p < .01). The results suggest that health care networks should apply this system to care for older adults at risk for stroke, helping them successfully access the hospital within the targeted time period."