Intended for healthcare professionals

Education And Debate

Controversies in Management: Community care allows patients to reach their full potential

BMJ 1994; 309 doi: (Published 19 November 1994) Cite this as: BMJ 1994;309:1356
  1. J Young
  1. Department of Health Care for the Elderly, St Luke's Hospital, Bradford BD5 0NA.

    Hospital based care currently dominates the management of stroke in Britain. This has been an insidious and unplanned process, and it is concerning that this acute care model may become regarded as the solution to stroke. I do not believe that hospital care should be replaced by community services but that a more appropriate balance needs to be achieved: one which recognises the limitations of hospitals and the pressing community (home) needs of stroke patients and their families.

    * This is the tenth in a series of articles examining some of the difficult decisions that arise in medicine

    Up to 70% of people who have a stroke are admitted to hospital, where they account for 12% of general medical and 25% of geriatric bed days. However, these widely cited statistics disguise considerable variations between districts, and it has become apparent that most stroke patients do not require hospital admission for medical reasons. Rather, the hospital is used as a form of rapid access sanctuary. It is a refuge for stroke patients who are socially disadvantaged (most commonly those living alone) and provides terminal or palliative care for those most severely affected.1 But while hospitals remain the default service for stroke, progress in community care initiatives will be stifled. Stroke, with its rapid response …

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