Dates

01/02/2014 to 31/07/2014

Overview

Purpose of proposed investigation

The aim of our research would be to develop an enhanced understanding of stroke patients in the predominantly remote and rural Highlands of Scotland. This epidemiological study would focus on the primary care provided to patients and their route to receiving care. We hope to identify the key constraints on delivering ‘optimal’ immediate care to rural stroke patients.

Background of project

The Highlands of Scotland represent a considerable challenge to the delivery of fast and effective immediate care to stroke patients. Much of the Highlands is classified as ‘Very Remote Rural’, defined as “An area with a population of less than 3,000 people, and with a drive time of over 60 minutes to a Settlement of 10,000 or more” (Scottish Government, 2010, p5). Rural transportation networks tend to be poor, with many routes susceptible to closure. Air transport is also limited as there are only two Scottish Ambulance Service helicopters serving the whole of Scotland. These factors very much limit the speed at which patients can be reached after they have suffered a stroke (e.g. by ambulance), and increase the time it takes to reach definitive care. It is also conceivable that rural residents have less awareness of the immediate symptoms of stroke through sheer distance from healthcare resources and restricted access to stroke awareness campaigns such as FAST. Indeed, there is anecdotal evidence that patients in the Highlands report the symptoms of a stroke to healthcare professionals later. However, it is important to note that Chest Heart and Stroke Scotland nurses are already involved in the community follow-up of stroke in the Highland region.

Care pathways developed for the more populated areas of Scotland are perhaps not appropriate for the less populated Highlands of Scotland, and as such a unique model of service delivery and evaluation could be pivotal to enhancing stroke outcome in rural areas.

Plan of investigation

We would extract anonymised patient data from two pre-existing data sets; 1) data collected by NHS Highland as part of the Scottish Stroke Care Audit, and 2) data routinely collected by the Scottish Ambulance Service (approximately 50% of stroke patients are transported to hospital by ambulance). This study would include four years of stroke patient data recorded between 2009 and 2012.

Funded by

Chest Heart and Stroke Scotland

With thanks to theScottish Ambulance Service