| Background and purposeStroke is a common disease that is harmful to people’s health. It is estimated that there are about 2 million new cases in country every year, With the increase in the aging population, and the number will continue to rise as the population ages. Most of patients discharged after hospitalization after the acute phase of stroke, up to75% of them sill left with certain degree of physical activity dysfunction,which seriously affecting the quality of their life and being a heavy burden on families. Since standard rehabilitation therapy can improve the functional disorders and living auality, thus reduce the burden of the family, community specification rehabilitation should be referred to stroke patients after they discharge from hospitaShunde is located in the economically developed Pearl River Delta region, has four district offices, six towns, and there are 85 neighborhood committees and 108 village committees in the jurisdiction, the resident population is over 248 million people.At present, the region has 14 general hospitals,10 community health centers. With the growth in the number of patients with stroke, more stroke patients need further community rehabilitation. while the develop situation of community rehabilitation in shunde for stroke is pretty slow, the persent comprehensive rehabilitation resources in the general hospital can not meet the needs of public hygiene. This survey intends to Investigate the present rehabilitation situations in Shunde, raise problems,and propose solutions, thus provides basis to policy-setting.Subjects and Methods1. the survey1.1. This paper studies those stroke patients who lives within 10 towns in Foshan and hospitalized in Shunde First People’s Hospital without age or gender limitation. Diagnostic criteria refers to "Diagnostic points of cerebrovascular diseases" revised on the Fourth National Academic Meeting for Cerebrovascular Disease by The Chinese Medical Association in 1995.1.2. By questionnaire and random sampling, we investigate that some of the physicians specializing in stroke treatment from comprehensive hospitals on how they offer further guidance of out-patient rehabilitation and awareness of community rehabilitation.1.3.After investigating the rehabilitation department officers of 12 comprehensive hospitals, we can better understand how rehabilitation department constructs.1.4. After investigating the health service center offices in 10 towns, we can better understand the status of rehabilitation equipments and staff and how the treatment project operates.2.Research Methods2.1. Based on the investigation purposes, we design the questionnaire into four parts: A. Stroke out patients from comprehensive hospitals; B. Physicians specializing on stroke patient treatment from comprehensive hospitals:C. Rehabilitation departments in comprehensive hospitals; D. Rehabilitation status of community health service center.2.2. The questionnaire to patients includes three parts:(1) common questions including patient’s age, gender, living place, out-patient diagnose and rehabilitation status; (2) Bathel criteria including professional investigators mark the patients on their self-care ability through the designed questionnaire. (3)Treatment after hospitalization including if continue to receive treatment, treatment methods, how they seek medical advice and its reason, how much the patients and their relatives know about rehabilitation treatment and community rehabilitation.2.3. Stratified random sampling method is used for selected patients or their custodian by telephone follow-up and questionnaire survey.2.4. Investigation physician’s awareness of rehabilitation treatmenting in stroke patients from comprehensive hospitals. By group sampling and questionnaire, we chose 5 out of 14 comprehensive hospitals as survey objects, investigating physicians on their awareness of three-stage-rehabilitation and community rehabilitation and how they guide patients to receive further treatment after hospitalization.2.5. Investigation rehabilitation department construction in comprehensive hospitals and community health service center. By cluster sampling survey, we investigate totally 10 facilities out of 12 comprehensive hospitals and community health service centers in each town. Referring to the "Guangdong Rehabilitation Medical Service Resources Survey" in March 2013, we will assess if these facilities have established rehabilitation departments in conformity with the specification and have qualitified medical staff with professional background, and how the rehabilitation projects develop.3. Statistical AnalysisStatistical professionals is appointed to arrange all the data, removing the invalid questionnaire. By establishing the SPSS 16.0 data base, we can have descriptive analysis to all the questions and adopt "Pearson Analysis" to analyze relations between each variable.Results1.Prent rehabilitation condition of the subjectsl1.1.In this case, there are 102 patients, including 62 men and 40 women, which account for 60.8% and 39.2%.13 patients under 50 years old,30 patients between the age of 50 to 60,23 patients between the age of 60 to 70 years old, and 36 patients are over 70 years old, which account for 12.7%,29.4%,22.5% and 35.3% respectively. According to etiology,24 patients are Hemorrhagic stroke and 78 patients are cerebral arterial thrombosis, which account for 23.5% and 76.5%. According to the progression,43 patients are experiencing the convalescence while 59 patients are experiencing the sequela, which account for 42.2% and 57.8%.1.2.There are 101 patients insist taking medicine after hospital, which account for 99%. Among them, there are 42 patients have simple physical training at home, only 10 patients have normative rehabilitative treatment in special medical institution,which account for 9.8%. Lack of the importance about rehabilitative treatment, and no prefessional organs around are the reasons they don’t keep on training. Among them,64.7% patients treat in the district hospital,23.5% treat in the town hospital, and only 18.6% treat in the community hospital. There aren’t any community hospital around, or they don’t believe in community physicians, became the reasons that they don’t choose community hospitals.1.3. Chi-square analysis showed that, people with different degree of functional defect have different degree of urgency for rehabilitation. The lower the Bathel score, the more hungry for rehabilitation. It reflected that the heavier the symptom, the more hungry for rehabilitation. Moderate and the following functional defect people, whose Bathel score is less than 70, account for 40.2% in the whole. They need some help in daily life, or totally depend on others, therefore they have demand for rehabilitative treatment. But there are only 10% of them find special institution for help. It declared that most patients have demand for rehabilitative treatment, but haven’t train in the community.2. The rehabilitation consciousness of doctors in general hospitalsThere are 67 doctors participated in the survey,79.1% of them know three-stage rehabilitation of stroke, while the rest don’t. The result showed that, more than 75% of the stoke patients, the one who is under the charge of 91% of doctors in the survey, got rehabilitative treatment during hospitalization. Except a doctor’s patients, at least a half of them, haven’t got rehabilitative treatment during hospitalization. According to rehabilitative pattern,70.2% of the doctors in Shunde like to combine medication, traditional rehabilitative treatment and modern rehabilitation in therapy. Accoding to discharge suggestions,37 doctors suggested patients to treat in the department of rehabilitation medicine at hospital,26 doctors suggested patients to treat in the community health centre, and 2 doctors hadn’t give any suggestion.3. Construction of rehabilitative treatment in general hospital3.1 All of the 14 general hospitals in the survey have set up Ddepartment of rehabilitation medicine, providing rehabilitation for patients with stroke. There are 91 doctors in all(21 have advance professional title,70 have intermediate and the following title), which rehabilitation specialty accouts for 17.6%, traditional Chinese medicin accouts for 68.1% and the rest accounts for 14.3%. And there are 94 rehabilitative therapists in all(only 7.4% of them have advance professional title, the rest 92.6% have primary and the following title),which 79.8% of them have practicing qualifications.3.2 Accoding to therapeutic tool, all of the 14 general hospitals in Shunde can provide traditional rehabilitative treatment, besides,8 of them can also provide physical therapy, occupational therapy and speech therapy, the other 6 hospitals can also provide physical therapy and occupational therapy. According to the total value of rehabilitation equipment, it worth less than 50 million yuan to 6 hospitals each,50 million yuan to 100 million yuan to 3 hospitals each, and more than 100 million yuan to 5 hospitals each.4. Construction of rehabilitative treatment in the community health centreAll of the 10 community health centres in the survey have set up rehabilitation treatment room, but only 6 of them can provide rehabilitation for patients with stroke, while the others lack professionals to practice. The 6 centres operate physicotherapeutics and acupunture for muscle soreness in neck, shoulder and lumbocrural.5 of them engage in traditional rehabilitative treatment instead of main rehabilitative treatment like speech therapy and occupational therapy.69 community health stations are attached to the 10 community health centres, only 12 of them can provide rehabilitative treatment for neck, shoulder and lumbocrural pain, including 2 stations which operate rehabilitative training for stroke patients.Professionals who can provide rehabilitative treatment is so inadequate that there are only 8 doctors of Chinese medicine and 4 therapeutist without practicing requirements in the 6 community health centres. Also, rehabilitative equipment in these centres is not enough, the total value of it is less than 20000 yuan. These centres operate acupunture for pain of neck, shoulder and lumbocrural mainly, and a few rehabilitative treatments for stroke patients.Conclusion(1) Most stroke patients got rehabilitative treatment during hospitalization, while no more normal training after dischargel and barely be treated in the community hospital. It’s due to the lack of guideness from doctors, poor quaility of treatment in the community, and the lack of confidence in community treatment.(2) Uneven allocation of resources lead to poor equitments, fewer professional and less launched projects.(3) Most rehabilitative professionals of general hospital in Shunde district major in Chinese Medicine instead of rehabilitation. Structure of personnel and the scale of equipment can’t reach the standard of Ministry of Health.(4) To raise the rate of rehabilitative treatment of stroke patients after hospital, we should firstly strenthen the rehabilitative education to stroke patients.,build community assistance model. Thirdly, improve the construction of rehabilitation in the community. Fourthly, establish a two-way referral system. Fifthly, operate family rehabilitative practice. |
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