The provision of best-practice care: examining modifiable barriers along the care pathway for stroke

Stroke is the second leading cause of adult death worldwide, and the third leading cause of disability-adjusted life-years. There is strong evidence that patients who have had a stroke, and those at risk of stroke, are not receiving best-practice stroke care according to clinical practice guidelines, with an evidence-practice gap being reported at multiple stages along the care pathway. Given the preventable nature of stroke, and the substantial burden that it imposes, an examination of the barriers to best-practice stroke care is needed. This thesis examines potential barriers to the provision of best-practice stroke care in Australian health care settings, from prevention in primary care, through to treatment in acute care. It comprises an introduction, six data-based papers, a systematic review, and a final discussion of the thesis findings. The seven papers that comprise this thesis examine: In primary care settings: Rates of general practitioner (GP) detection of patient health risk factors for stroke (Paper One). Patient awareness of stroke symptoms, and the appropriate action to take in the event of a stroke (Paper Two). In acute care settings: Emergency physicians’ perspectives of acute stroke treatment, and the enablers to the provision of treatment (Papers Three and Four). The effectiveness of interventions to improve patient-practitioner communication interventions involving treatment decision making (Paper Five).Patient preferences, knowledge and acceptability surrounding the communication of acute stroke treatment, and hypothetical treatment decisions (Papers Six and Seven).