Stroke care in australia: Why is it still the poor cousin of health care?

Stroke prevention and management have changed, but most patients are not benefiting from these changes.
The National Stroke Foundation’s recent rehabilitation services audit report confirms that only a small proportion of Australians receive evidence-based care.1 The gap between best evidence-based and actual care in many areas of stroke is staggering.
For example, only 44% of patients transferred to rehabilitation had been in a stroke unit. This mirrors the acute care services audit finding that many patients do not receive dedicated stroke unit care,2 despite overwhelming evidence of effectiveness.3 Only 7% of ischaemic stroke patients received thrombolysis treatment,2 yet for every 100 patients who receive it, there are up to 10 extra independent survivors.4 About 20% of stroke patients are discharged from hospital without medication (to lower cholesterol and blood pressure) to prevent recurrent stroke;2 however, for every 100 people treated with blood-pressure-lowering medication, three people are saved from death and/or disability from recurrent stroke and cardiovascular events.3 Over one-third of patients are put at risk of complications because their swallowing ability is not assessed before being given food, drink or oral medications.2 Despite the contribution of lifestyle risk factors to secondary stroke risk, almost half (47%) of patients do not receive lifestyle risk factor modification advice.1 Only 37% of patients are referred for community rehabilitation,1 although for every 100 people who receive it, six are saved from death and/or disability.3 For virtually every important quality indicator, outcomes are better if patients had been in a stroke unit, or in a hospital treating over 100 stroke patients per year.