How Do Stroke Survivors, Relatives, and Experts Experience Post-Stroke Care After Completion of a Medical Rehabilitation Measure? Results of a Qualitative Study

Während das deutsche Gesundheitssystem über eine hervorragende medizinische Akutversorgung (Stroke Unit) von Menschen nach Schlaganfall verfügt, sind es der Entlassungsprozess und die poststationäre Betreuung nach Abschluss einer Rehabilitationsmaßnahme, in denen noch immer Unter- und Fehlversorgungen auftreten. Ziel der hier vorgestellten Studie war es, basierend auf den Erfahrungen aller Teilnehmenden Empfehlungen für eine Verbesserung im Nachsorgeprozess zu formulieren. Insgesamt wurden 19 Personen mithilfe von leitfadengestützten Interviews befragt, sechs Expertinnen und Experten aus der ärztlichen und therapeutischen Versorgung sowie sieben Menschen nach Schlaganfall und sechs Angehörige. Die audiodokumentierten Interviews wurden mit der Analysesoftware MAXQDA transkribiert und nach dem Verfahren der qualitativen Inhaltsanalyse nach KUCKARTZ (2016) ausgewertet. Die Ergebnisse zeigen, dass insbesondere der Zeitpunkt der Weitergabe von Informationen, die Einbindung der Angehörigen sowie die Budgetierung im deutschen Gesundheitswesen Versorgungslücken und Versorgungsabbrüche in der Nachsorge beeinflussen und somit Ansatzpunkte zur Verbesserung bieten können.While the German healthcare system has an excellent medical acute care treatment system (stroke unit) for stroke victims, it is the discharge process and post-inpatient follow-up care after the completion of a rehabilitation measure in which misuse still occur. The aim of my study has been to formulate recommendations for improvements in the aftercare process based on the experiences of the participants. All in all, 19 persons were interviewed, six experts from medical and therapeutic care, seven stroke victims, and six relatives took part in the interviews. The audio-documented interviews were transcribed with the analysis software MAXQDA and analyzed using qualitative content analysis (KUCKARTZ, 2016). The results show that the dissemination of information, the involvement of relatives, and the budgeting in the German health care system can influence gaps and interruptions in follow-up care and thus offer starting points for improvement

Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany

Purpose We compared the perception of office-based haematologists and oncologists regarding the availability of outpatient psycho-social support services (PSSS) for patients with cancer and a migration background, as well as their different experiences with these services. Methods Data were collected via an online survey addressing the doctors’ socio-demographic characteristics and their perception of-and experience with PSSS. The association between socio-demographic characteristics of the doctors and their experiences with PSSS was tested using Pearson’s chi-squared test and Kruskal–Wallis test. Results A total of 55 doctors were included in this study. More than three doctors in four reported non-sufficient presence of PSSS in foreign languages in their region; one in two reported that the services for patients with migration background should be improved. Most doctors reported missing PSSS in Turkish and Arabic in their region. Doctors with less experience referred patients more often to PSSS hosted in patients’ associations (75% vs 25%; p = 0.02), than doctors with more experience. Doctors working in larger cities referred patients less often to PSSS in cancer counselling centres (12% vs 88%; p = 0.01), than doctors working in small or middle-large cities. Male doctors were more satisfied with the network of PSSS’ providers, than female doctors (mean score = 2.8 vs 2.2; p = 0.05). Conclusions Our results suggest that efforts should be made for a higher regional availability of overall and specific PSSS for non-German speaking patients (especially for Turkish- and Arabic-speaking patients). The experience with PSSS was associated with the doctors’ work experience and gender, as well as the location of the practice

Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

Abstract Background Although Germany’s acute care for stroke patients already has a good reputation, continuous follow-up care is still not widely available, a problem originating in the strict separation of inpatient and outpatient care. This gap in the German health care system does not just lead to patients’ potential readmission to inpatient care and compromise the sustainability of what they have accomplished during medical rehabilitation; it also places a burden on caregivers. Methods To illustrate the current procedures on follow-up care of stroke patients in Germany, a systematic literature search was conducted to gather all available evidence. Research articles in the English or German language were searched between 2007 and 2017. Different study designs ranging from non-experimental descriptive studies, expert reports and opinions were included and categorised by two independent researchers. Relevant data was electronically searched through international and national databases and incorporated in a summary grid to investigate research outcomes and realise a narrative synthesis. Results A literature search was conducted to identify all relevant information on how current follow-up care is carried out and evaluated in Germany. We identified no systematic reviews on this topic, but included a total of 18 publications of various original studies, reviews and expert opinions. Included study populations also differed in either: experts, caregivers or stroke patients, including their viewpoints on the outpatient care situation of stroke patients; to capture their need for assistance or to investigate caregivers need and use for assistance. So far there is no standardised follow-up care in Germany, but this review reveals that multidisciplinary cooperation within occupational groups in outpatient rehabilitation is a key item that can influence and improve the follow-up care of stroke patients. Conclusion This review was conducted to provide a broadly based overview of the current follow-up care of stroke patients in Germany. Both the new implementation of a standardised, discharge service that supports early support, to be initiated this year and numerous approaches are promising steps into the right direction to close the follow-up gap in German health care provision

Additional file 1: of Post-stroke care after medical rehabilitation in Germany: a systematic literature review of the current provision of stroke patients

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