22. European Stroke Conference 371 Management and economics Managing the post stroke patient in the community: Helping primary care doctors to screen for swallowing disorders using the iCaPPS-Swallow A.F. Abdul Aziz1, M.F. Ali2, N.S. Mohd Zawawi3, H. Hussain4, R. M Kamal5, Z. Che’ Man6, N.A. Aziz7, S.M. Aljunid8 United Nations University IIGH & Dept. Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA1, Dept. Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA2, Speech and Language Unit, Department of Medical Rehabilitation Services, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA3, Hospital Rehabilitasi, Cheras, Kuala Lumpur, Kuala Lumpur, MALAYSIA4, Speech and Audiology Department, School of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA5, Research Support Unit, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA6, Dept. Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA7, United Nations University IIGH, International Cen-tre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lum-pur, 482 © 2013 S. Karger AG, Basel Scientific Programme MALAYSIA8 Introduction Screening for swallowing problems is advocated due to high prevalence among stroke patients. However, local data on awareness among health professionals towards screening and utilisation of speech-language therapy (SLT) services is low resulting in scarcity of data on prevalence of swal-lowing disorders among stroke survivors. A screening checklist with simplified care algorithm was designed to alert primary care team to detect potential patients likely to benefit from SLT assessment and intervention. Methods Expert panel discussions comprising Family Physicians, Neurologists, Rehabilitation Physicians and Speech-Language Therapists, and Nurse Managers from both Ministry of Health and Acadaemia were conducted. Problems related to management of swallowing disorders among post stroke pa-tients were identified. Further discussions among SLT team were conducted to design the Integrated Care Pathway for Post Stroke patients-Swallowing screen checklist (iCaPPS-swallow) to facilitate timely referrals and intervention from the community to centres providing SLT services. Modified Delphi technique was employed to facilitate variances in practice. Results The iCaPPS-Swallow checklist addressed 3 main categories of post stroke patients encountered in primary care: (1) patients on nasogastric tube feeding beyond 6 weeks duration, (2) patients who de-veloped symptoms after discharge from tertiary care and had not been screened (3) patients who de-veloped new symptoms while residing at home in the community. Patients with positive symptoms for swallowing disorders were prompted for early SLT referrals. Patients on nasogastric tube feeding discharged home without plans for assessment or defaulted Specialist reviews required immediate referral. Discussion The iCaPPS-swallow caters for missed opportunities for screening of swallowing disorders among post stroke patients residing at home in the community and those managed at primary care-led post stroke services. 372 Management and economics Promoting Seamless Transfer-of-Care For Stroke Patients in Primary Care: Development of the integrated Care Pathway for Post Stroke (iCaPPS) services in developing countries A.F. Abdul Aziz1, N.A. Aziz2, N.A. Mohd Nordin3, B.S. Saperi4, S.M. Aljunid5 United Nations University IIGH & Dept. Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA1, Dept. Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MALAYSIA2, United Nations University IIGH & School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MALAYSIA3, Department of Health Information, University Kebangsaan Malaysia Medi-cal Centre, Kuala Lumpur, MALAYSIA4, United Nations University IIGH, International Centre for Casemix & Clinical Coding, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MA-LAYSIA5 Introduction Post-stroke care after hospital discharge suffers from lack of intersectoral collaboration within pub-lic health sectors. Hence, primary care remains the only option in managing stroke patients in under-served areas in Malaysia. A seamless transfer of care model known as integrated Care Pathway for Post Stroke patients (iCaPPS) was designed to address this issue. The iCaPPS would provide a de-tailed guide designed by local experts based on a shared care approach with primary care to manage post stroke patients in underserved areas while utilising available resources within community. Methods Expert panel discussions comprising Family Physicians, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from both Ministry of Health and acadaemia were conducted. Modified Delphi technique was employed to resolve practice variances requiring further literature support. Care algorithms were designed around existing work schedules and available resources at public healthcentres. Results Care algorithm including appropriate tools were summarised to guide primary care team to identify patients requiring further multidisciplinary rehabilitation interventions. The multidisciplinary in-terventions included rehabilitation assessment for the uninitiated and leisure intervention for those indicated, screening for swallowing disorders as well as mental health disorders. Indications for re-ferral Specialist Stroke care team were outlined. Periodic screening for stroke related complications were scheduled into the iCaPPS. Conclusion The iCaPPS would facilitate coordinated post stroke care for patients residing at home in the com-munity and patients lacking access to Specialised Stroke care. The role of the primary care team as coordinators of post stroke care at community level is well defined. Clinical outcomes and cost ef-fectiveness of iCaPPS can be evaluated for benefit of stakeholders and stroke survivors.
Karger_ESC London_2013
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