Secondary stroke prevention services in Canada: a cross-sectional survey and geospatial analysis of resources, capacity and geographic access

Lauren Jewett, Adil Harroud, Michael D. Hill, Robert Côté, Theodore Wein, Eric E. Smith, Gord Gubitz, Andrew M. Demchuk, Demetrios J. Sahlas, David J. Gladstone, M. Patrice Lindsay

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

BACKGROUND: Rapid assessment and management of transient ischemic attacks and nondisabling strokes by specialized stroke prevention services reduces the risk of recurrent stroke and improves outcomes. In Canada, with its vast geography and with 16.8% of the population living in rural areas, access to these services is challenging, and considerable variation in access to care exists. The purpose of this multiphase study was to identify sites across Canada providing stroke prevention services, evaluate resource capacity and determine geographic access for Canadians. METHODS: We developed a Stroke Prevention Services Resource Inventory that contained 22 questions on the organization and delivery of stroke prevention services and quality monitoring. The inventory ran from November 2015 to January 2016 and was administered online. We conducted a geospatial analysis to estimate access by drive times. Considerations were made for hours of operation and access within and across provincial borders. RESULTS: A total of 123 stroke prevention sites were identified, of which 119 (96.7%) completed the inventory. Most (95) are designated stroke prevention or rapid assessment clinics. Of the 119 sites, 68 operate full time, and 39 operate less than 2.5 days per week. A total of 87.3% of the Canadian population has access to a stroke prevention service within a 1-hour drive; however, only 69.2% has access to a service that operates 5-7 days a week. Allowing provincial border crossing improves access (< 6-h drive) for those who are beyond a 6-hour drive within their home province (3.4%). INTERPRETATION: Most Canadians have reasonable geographic access to stroke prevention services. Allowing patients to cross borders improves the existing access for many, particularly some remote communities along the Ontario-Quebec and British Columbia-Alberta borders.

Original languageEnglish
Pages (from-to)E95-E102
JournalCMAJ open
Volume6
Issue number1
DOIs
Publication statusPublished - Feb 21 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright 2018, Joule Inc. or its licensors.

ASJC Scopus Subject Areas

  • General Medicine

PubMed: MeSH publication types

  • Journal Article

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