A new model of care is being delivered to Counties Manukau Health (CM Health) stroke patients.
All stroke patients who have been discharged from hospital and require further rehabilitation will now receive care from the Community Stroke Rehabilitation Team, which is a merger of two former care teams – Early Supported Discharge, and the Community Based Rehabilitation Team.
Amanda Shapleski, section head of the Community Stroke Rehabilitation Team, says early supported discharge (ESD) is now standard practice and there is significant international research to show discharging stroke patients from hospital earlier produces equal, if not better, results for patients and is more cost effective.
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Geriatrician Geoff Green, who is CM Health’s clinical lead for Stroke Services, agrees. He argues that rehabilitating at home is often more effective for patients because they are usually completing far more meaningful and practical tasks or “self-directed rehabilitation”, such as making a cup of tea.
“Home is a much richer and more familiar environment,” Dr Green says, noting self-directed community rehabilitation has been proven effective in randomised control trials.
CM Health was the first DHB to introduce specialised ESD for stroke, and initially trialled the service in 2013 as part of Ko Awatea’s (CM Health’s centre for health innovation and improvement) 20,000 Days Campaign, which aimed to return 20,000 healthy and well days to the community.
Previously the Community Based Rehabilitation Team treated patients within the community who had completed inpatient rehabilitation but needed further help. This was at a lower intensity service than for ESD.
Having separate services, however, meant patients had to change therapists as they moved from more intense therapy to less intense therapy, and therefore experienced unfortunate disruptions in continuity of care.
Under the Community Stroke Rehabilitation Team model, patients see the same therapist for the duration of their care because all therapists work across both models, Ms Shapleski says.
Patients requiring higher intensity care (formerly ESD care) have a therapist visit their home anywhere from one to three times a day, while patients requiring less intense care will have anywhere between one to four visits per week, she says.
As patients graduate from higher intensity care they will see a natural decrease in the number of visits rather than a changeover in therapist.
Patients have been overwhelmingly satisfied with the service and there has been a 99.5 per cent positive response rate to the patient feedback survey, Ms Shapleski says.
One patient happy with his treatment is Haedon Ngatae, who credits his recovery from his November 12 stroke to the support of the Community Based Rehabilitation team, and the continuity of care the team has offered. “I saw the same person, that was the bonus. They build that relationship up and they egg you on to continue.”
Mr Ngatae, who was released from hospital in December, now walks every day and has lost around 45kg in weight. He says his therapist helped him to practice simple tasks at home such as holding jars of jam and tightening bolts, and he frequently looked forward to her visits to see what kind of activity he was doing that day. His therapist, in turn, was impressed with his commitment to his recovery. “She was rapt I never gave up.”