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Specialist stroke support costs NHS less

Early treatments in specialist clinics is effective for stroke

OnMedica Staff

Thursday, 05 February 2009

Six months after minor stroke or transient ischaemic attack, patients treated in specialist clinics are still doing better than those treated in the standard way – and they are costing the NHS less, finds a study in the Lancet Neurology journal.

Oxford researchers today published the second part of the Express study comparing the two groups on hospital admissions, costs and disability after six months.

Standard treatment took place from 2002-2004. A GP referred each patient with non-disabling stroke or TIA symptoms to the study clinic. Clinic staff made an appointment with the patient for assessment. The patient was then referred back to the GP with details of the required treatments.

Specialist support took place from 2004-2007. This time, patients were immediately sent by GPs to the study clinic, which then carried out immediate assessment and treatments. 

The first part, reported in October 2007, showed that urgent assessment and immediate treatment reduced the risk of recurrent stroke within the first 90 days by 80%, compared with patients treated in the standard way.

In the second part, the teams from the Stroke Prevention Research Unit at the John Radcliffe Hospital and the University of Oxford found that those treated immediately in the specialist clinics had a lower 90-day risk of fatal or disabling stroke than those treated through the usual referral process (1 of 281 patients compared with 16 of 310).

There were only five hospital admissions for those that had been treated in specialist clinics compared to 25 for those treated in the standard way. Hospital bed-days used due to stroke and other cardiovascular causes were also lower - 427 days compared to 1365 days. Each patient treated by the specialist clinics saved the NHS an average of £624.

Eight patients in each group improved from disability to no disability over six months.

But more patients treated in the standard way were disabled at six months than those treated by specialist clinics (33 of 310 compared to 16 of 281).

If extrapolated for the UK as a whole, the authors say their findings would prevent around 10,000 strokes a year, generate savings of 290,000 hospital bed-days and monetary savings of £68 million in acute care costs with additional savings on community services.

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